Provider Demographics
NPI:1740390293
Name:PEGOLO, GIOVANNA (MD)
Entity Type:Individual
Prefix:
First Name:GIOVANNA
Middle Name:
Last Name:PEGOLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 E GREEN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2084
Mailing Address - Country:US
Mailing Address - Phone:626-744-1880
Mailing Address - Fax:626-744-5316
Practice Address - Street 1:572 E GREEN ST STE 302
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2084
Practice Address - Country:US
Practice Address - Phone:626-744-1880
Practice Address - Fax:626-744-5316
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA541722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry