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General NPI Number Information
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NPI Number | 1790774297
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Entity Type | Individual
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Provider Name | JAIME PEDRAZA P.A.
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Gender | Male
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 30 MEDICAL CENTER BLVD BLDG 1
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City | CHESTER
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State | PA
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Zip | 19013-3955
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Country | US
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Telephone | 610-874-6448
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Fax |
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Provider Business Mailing Address
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Address Line | 1 MEDICAL CENTER BLVD
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City | CHESTER
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State | PA
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Zip | 19013-3902
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Country | US
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Telephone | 610-619-7360
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Fax | 610-619-7366
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2779
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License Number State | FL
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