Provider Demographics
NPI:1699418376
Name:PEDRAJA ALFONSO, VANEZA
Entity type:Individual
Prefix:
First Name:VANEZA
Middle Name:
Last Name:PEDRAJA ALFONSO
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 1:7251 BOX ELDER DR
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6972
Mailing Address - Country:US
Mailing Address - Phone:727-326-2687
Mailing Address - Fax:
Practice Address - Street 1:7251 BOX ELDER DR
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6972
Practice Address - Country:US
Practice Address - Phone:727-326-2687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician