Provider Demographics
NPI:1972936862
Name:PELLEGRINI, NAT PETER
Entity Type:Individual
Prefix:MR
First Name:NAT
Middle Name:PETER
Last Name:PELLEGRINI
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 1:13656 W NOGALES DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-6888
Mailing Address - Country:US
Mailing Address - Phone:623-518-4424
Mailing Address - Fax:
Practice Address - Street 1:13656 W NOGALES DR
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-6888
Practice Address - Country:US
Practice Address - Phone:623-518-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ906422171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor