Provider Demographics
NPI:1699329037
Name:PEDROZO, MELISSA ANNE (EAMP, LAC)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANNE
Last Name:PEDROZO
Suffix:
Gender:F
Credentials:EAMP, LAC
Other - Prefix:MS
Other - First Name:MEESA
Other - Middle Name:
Other - Last Name:PEDROZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EAMP, LAC
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-0820
Mailing Address - Country:US
Mailing Address - Phone:253-905-5848
Mailing Address - Fax:
Practice Address - Street 1:1944 PACIFIC AVE STE 301A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3121
Practice Address - Country:US
Practice Address - Phone:253-905-5848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60979180171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist