Provider Demographics
NPI:1982178117
Name:PEDRAZA, JACQUELINE OLIVIA (RBT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:OLIVIA
Last Name:PEDRAZA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SW 135TH WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3466
Mailing Address - Country:US
Mailing Address - Phone:954-552-2351
Mailing Address - Fax:
Practice Address - Street 1:1900 SW 135TH WAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3466
Practice Address - Country:US
Practice Address - Phone:954-552-2351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty