Healthcare Provider Details

I. General information

NPI: 1639002801
Provider Name (Legal Business Name): NICOLE PEDRAZA HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 VANCE DR STE 195
ARVADA CO
80003-2132
US

IV. Provider business mailing address

5410 W MAGDALENA LN
LAVEEN AZ
85339-2878
US

V. Phone/Fax

Practice location:
  • Phone: 303-432-3601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0000383
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: