Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A51722 | CA |
N | 207QA0505X | Family Doctor - Adult Medicine | A51722 | CA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | A51722 | CA |
N | 207R00000X | Internist | A51722 | CA |
N | 111NI0900X | Internist | A51722 | CA |
N | 207RA0201X | Internist - Allergy & Immunology | A51722 | CA |
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | A51722 | CA |
N | 207RG0300X | Geriatric Medicine | A51722 | CA |
NPI | 1760527055 |
---|---|
Provider Name | Dr. Victor M. Pedroza |
First Address | Los Angeles, CA 90023-1441 |
Second Address | Los Angeles, CA 90023-1441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 06/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A517220 | (05) | CA |
00A517220 | MEDI-CAL (01) | CA |
F83759 | (02) | CA |