Healthcare Provider Details

I. General information

NPI: 1134715162
Provider Name (Legal Business Name): KALI PELLEGRINO FNP-C, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 E BASELINE RD STE 400
GILBERT AZ
85234-2472
US

IV. Provider business mailing address

3425 E MOCKINGBIRD DR
GILBERT AZ
85234-2224
US

V. Phone/Fax

Practice location:
  • Phone: 480-494-5357
  • Fax:
Mailing address:
  • Phone: 203-231-1506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number247797
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: