Provider Demographics
NPI:1790298271
Name:PELOSI, AUGUSTA (DVM)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTA
Middle Name:
Last Name:PELOSI
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 S CENTRAL BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7395
Mailing Address - Country:US
Mailing Address - Phone:561-250-6580
Mailing Address - Fax:
Practice Address - Street 1:1680 S CENTRAL BLVD STE 112
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7395
Practice Address - Country:US
Practice Address - Phone:561-250-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLVM13747246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Single Specialty