Provider Demographics
NPI:1851323026
Name:PEDRAZA, BENITO A
Entity Type:Individual
Prefix:
First Name:BENITO
Middle Name:A
Last Name:PEDRAZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 N BRENT ST
Mailing Address - Street 2:STE 404
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-641-6525
Mailing Address - Fax:805-641-6530
Practice Address - Street 1:168 N BRENT ST
Practice Address - Street 2:STE 404
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-641-6525
Practice Address - Fax:805-641-6530
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78582207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology