Devallee Pedrogo, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

53093 Issued in CA

Practice address

22342 El Paseo Ste G
Rancho Santa Margarita, CA 92688-5804

Phone

(949) 876-5329

NPI assigned

Jan 24, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706054400000",
    "number": "1255193579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26655 AVENIDA DESEO",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926914301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22342 EL PASEO STE G",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926885804",
            "telephone_number": "949-876-5329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDROGO",
        "first_name": "DEVALLEE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-01-24",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "53093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lillian Man Phan, DPT

• Physical Therapy Assistant in Rancho Santa Margarita, CA
• Providers in Rancho Santa Margarita, CA by specialty
• Physical Therapy Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.