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Individual

MS. CANDICE ROSEANNE PELLEGRINO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.P.A.C., P.A.-C

Contact information

Practice address
302 UNIVERSITY BLVD, ROUND ROCK, TX 78665-1032
(512) 509-0200
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-8800

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA01105
TX
363AM0700X
Medical Physician Assistant
Primary
PA01105
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1821185299
AGENCY (BVCAA, INC.) NPI
TX
Enumeration date
07/26/2006
Last updated
05/22/2024
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