Provider Demographics
NPI:1245849314
Name:PEDROZA, ANNAMARIE RAE (13298-R)
Entity type:Individual
Prefix:
First Name:ANNAMARIE
Middle Name:RAE
Last Name:PEDROZA
Suffix:
Gender:F
Credentials:13298-R
Other - Prefix:
Other - First Name:ANNAMARIE
Other - Middle Name:RAE
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:13298-R
Mailing Address - Street 1:1405 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0748
Mailing Address - Country:US
Mailing Address - Phone:209-284-0970
Mailing Address - Fax:
Practice Address - Street 1:1405 11TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0748
Practice Address - Country:US
Practice Address - Phone:209-284-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor