Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD00025990 | WA |
N | 207QA0401X | Family Doctor - Addiction Medicine | MD00025990 | WA |
NPI | 1063426344 |
---|---|
Provider Name | Antonio Pedroza |
First Address | Renton, WA 98055-4934 |
Second Address | Renton, WA 98055-5738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 28/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E33386 | (02) | |
E33386 | (02) | WA |