Provider Demographics
NPI:1821832551
Name:PEDROZA, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PEDROZA
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 1:4241 E MALAGON PRIVADO UNIT 43
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-0623
Mailing Address - Country:US
Mailing Address - Phone:323-712-0739
Mailing Address - Fax:
Practice Address - Street 1:4241 E MALAGON PRIVADO UNIT 43
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-0623
Practice Address - Country:US
Practice Address - Phone:323-712-0739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant