Provider Demographics
NPI:1689412876
Name:PEDRAZA RICO, ANGELA J
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:J
Last Name:PEDRAZA RICO
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 1:8501 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-7017
Mailing Address - Country:US
Mailing Address - Phone:262-898-4551
Mailing Address - Fax:
Practice Address - Street 1:8501 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-7017
Practice Address - Country:US
Practice Address - Phone:262-898-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach