Provider Demographics
NPI:1447826557
Name:PEDRAZA, DISLEY
Entity type:Individual
Prefix:
First Name:DISLEY
Middle Name:
Last Name:PEDRAZA
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 1:100 HAMMOCKS TRL APT 2208
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-4863
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 HAMMOCKS TRL APT 2208
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-4863
Practice Address - Country:US
Practice Address - Phone:305-748-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-29
Last Update Date:2021-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program