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General NPI Number Information
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NPI Number | 1407612658
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Entity Type | Individual
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Provider Name | LORA PEDROSA PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 12/28/2024
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Provider Practice Location Address
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Address Line | 64 E BROADWAY RD
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City | TEMPE
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State | AZ
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Zip | 85282-1353
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Country | US
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Telephone | 928-655-6679
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Fax |
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Provider Business Mailing Address
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Address Line | 1226 E TREMAINE AVE
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City | GILBERT
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State | AZ
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Zip | 85234-4879
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 305971
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License Number State | AZ
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