Healthcare Provider Details

I. General information

NPI: 1538042858
Provider Name (Legal Business Name): ANDREA MARLENE PEDNEAULT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2025
Last Update Date: 07/26/2025
Certification Date: 07/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27555 YNEZ RD STE 201
TEMECULA CA
92591-4677
US

IV. Provider business mailing address

21828 CARNATION LN
WILDOMAR CA
92595-7810
US

V. Phone/Fax

Practice location:
  • Phone: 951-383-6068
  • Fax:
Mailing address:
  • Phone: 714-356-2260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: