Provider Demographics
NPI:1194481812
Name:PEDROZA MEDINA, MARIA PAULA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:PAULA
Last Name:PEDROZA MEDINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 W 21ST CT APT 408
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2689
Mailing Address - Country:US
Mailing Address - Phone:786-372-5935
Mailing Address - Fax:
Practice Address - Street 1:3 SW 129TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1779
Practice Address - Country:US
Practice Address - Phone:954-589-2539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician