Healthcare Provider Details

I. General information

NPI: 1104761352
Provider Name (Legal Business Name): ANGELICA LEEANNA PEDRAZA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 TENNYSON AVE STE 204
EUGENE OR
97408-4393
US

IV. Provider business mailing address

2911 TENNYSON AVE STE 204
EUGENE OR
97408-4393
US

V. Phone/Fax

Practice location:
  • Phone: 541-515-6194
  • Fax: 541-505-9574
Mailing address:
  • Phone: 541-515-6194
  • Fax: 541-505-9574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29591
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: