Provider Demographics
NPI:1316065741
Name:PEDROGO, IRIS M (MS)
Entity type:Individual
Prefix:PROF
First Name:IRIS
Middle Name:M
Last Name:PEDROGO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3000
Mailing Address - Street 2:SUITE 98
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-6000
Mailing Address - Country:US
Mailing Address - Phone:787-633-2936
Mailing Address - Fax:
Practice Address - Street 1:1731 PASEO LAS COLONIAS
Practice Address - Street 2:URB.CONSTANCIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2234
Practice Address - Country:US
Practice Address - Phone:787-647-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0549235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist