Healthcare Provider Details

I. General information

NPI: 1245153477
Provider Name (Legal Business Name): VIOLETA PEDERNAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W LEGION RD
BRAWLEY CA
92227-7780
US

IV. Provider business mailing address

633 CACTUS ST
IMPERIAL CA
92251-2514
US

V. Phone/Fax

Practice location:
  • Phone: 760-351-3278
  • Fax:
Mailing address:
  • Phone: 760-554-4752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: