Individual
IAN PEDREGOSA DY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
815 E ROSE LN UNIT 117, PHOENIX, AZ 85014-1915
(480) 280-8690
Mailing address
815 E ROSE LN UNIT 117, PHOENIX, AZ 85014-1915
(480) 280-8690
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
250388
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
250388
AZ
Other
Enumeration date
11/30/2020
Last updated
04/08/2024
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