Healthcare Provider Details

I. General information

NPI: 1710987573
Provider Name (Legal Business Name): ANGELA PEDRAZA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 PALM BEACH LAKES BLVD STE 1200
WEST PALM BEACH FL
33401-2214
US

IV. Provider business mailing address

1645 PALM BEACH LAKES BLVD STE 1200
WEST PALM BEACH FL
33401-2214
US

V. Phone/Fax

Practice location:
  • Phone: 561-687-2111
  • Fax: 561-687-1777
Mailing address:
  • Phone: 561-687-2111
  • Fax: 561-687-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0052121
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: