Provider Demographics
NPI:1245866656
Name:PEDROZA, FERNANDO JR (RDA)
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:
Last Name:PEDROZA
Suffix:JR
Gender:M
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7257 DOWDY ST # A
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-6123
Mailing Address - Country:US
Mailing Address - Phone:408-337-7688
Mailing Address - Fax:
Practice Address - Street 1:7257 DOWDY ST # A
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-6123
Practice Address - Country:US
Practice Address - Phone:408-337-7688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA90318126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant