Basic Information
| Provider Information | |||||||||
| NPI: | 1619133782 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEDROZA ALICEA | ||||||||
| FirstName: | MARIELIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6675 WESTWOOD BLVD | ||||||||
| Address2: | STE 475 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328216027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078450330 | ||||||||
| FaxNumber: | 8889721752 | ||||||||
| Practice Location | |||||||||
| Address1: | CARR 155 RAMAL SECTOR EL DESVIO | ||||||||
| Address2: | |||||||||
| City: | OROCOVIS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876499757 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2008 | ||||||||
| LastUpdateDate: | 02/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 17243 | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.