Healthcare Provider Details

I. General information

NPI: 1639345150
Provider Name (Legal Business Name): PAOLA PEDERZOLI-CARRILLO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 07/21/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE # 12-430
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

10833 LE CONTE AVE # 12-430
LOS ANGELES CA
90095-7901
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-4065
  • Fax: 310-825-9832
Mailing address:
  • Phone: 310-794-4065
  • Fax: 310-825-9832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number527692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: