Healthcare Provider Details

I. General information

NPI: 1114196540
Provider Name (Legal Business Name): RENE PEDROZA AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9016 RANCICH ST
EL PASO TX
79904-1029
US

IV. Provider business mailing address

18511 HIGHLANDER MEDICS ST BLDG 2496
FORT BLISS TX
79906-5327
US

V. Phone/Fax

Practice location:
  • Phone: 915-780-3449
  • Fax:
Mailing address:
  • Phone: 915-742-2524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: