Provider Demographics
NPI:1588600183
Name:DE LA PEDRAJA, HILDA M (PA)
Entity type:Individual
Prefix:
First Name:HILDA
Middle Name:M
Last Name:DE LA PEDRAJA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 NW 134TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2280
Mailing Address - Country:US
Mailing Address - Phone:305-370-5236
Mailing Address - Fax:
Practice Address - Street 1:1062 NW 134TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-2280
Practice Address - Country:US
Practice Address - Phone:305-370-5236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9100780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA 9100780OtherDEPARTMENT OF HEALTH