Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A130852 | CA |
NPI | 1003172347 |
---|---|
Provider Name | Dr. Tiffany Prugpichailers Pedigo |
First Address | Los Angeles, CA 90095-7419 |
Second Address | Los Angeles, CA 90095-7419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2012 |
Last Update Date | 07/06/2016 |