MEDICARE: VIRGINIA MARIA PEDREGUERA MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	IMH7235	FL
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1225361413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA MARIA PEDREGUERA MA

Provider Business Mailing Address
First Line	:	15256 SW 25TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5741
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15256 SW 25TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5741
Country	:	US
Telephone Number	:	305-773-6313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2009
Last Update Date	:	05/23/2016

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