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NPI Code Detail

MEDICARE: DEIRDRE PENDERGRASS BA

MEDICARE: DEIRDRE PENDERGRASS BA
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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1952432650
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEIRDRE PENDERGRASS BA
Provider Business Mailing Address
First Line : 3673 W CHAPMAN LN
Second Line :
City : INGLEWOOD
State : CA
Zip : 90305-2300
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3787 S VERMONT AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90007-4203
Country : US
Telephone Number : 323-766-2345
Fax Number : 323-766-3636
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 07/08/2007

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Directions to “ DEIRDRE PENDERGRASS BA” Practice Location

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