Healthcare Provider Details

I. General information

NPI: 1962632216
Provider Name (Legal Business Name): JASMINE PEDROSO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 SEVEN HILLS DR #140
HENDERSON NV
89052-4371
US

IV. Provider business mailing address

9260 W SUNSET RD # 200
LAS VEGAS NV
89148-4858
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-3547
  • Fax: 702-921-2419
Mailing address:
  • Phone: 702-255-3547
  • Fax: 702-921-2419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number14941
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: