Provider Demographics
NPI:1659130664
Name:PEDIGO, KORINAH REBUSTES (FNP-C, MSN, MBA)
Entity type:Individual
Prefix:
First Name:KORINAH
Middle Name:REBUSTES
Last Name:PEDIGO
Suffix:
Gender:F
Credentials:FNP-C, MSN, MBA
Other - Prefix:
Other - First Name:KORINAH
Other - Middle Name:ALEGRO
Other - Last Name:REBUSTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23639 HAWTHORNE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5985
Mailing Address - Country:US
Mailing Address - Phone:310-373-9980
Mailing Address - Fax:
Practice Address - Street 1:23639 HAWTHORNE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5985
Practice Address - Country:US
Practice Address - Phone:310-373-9980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily