1578729695 NPI number — MS. PEGGY ANNE RAIKES L.AC., M.ED., MTOM

Table of content: MS. PEGGY ANNE RAIKES L.AC., M.ED., MTOM (NPI 1578729695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578729695 NPI number — MS. PEGGY ANNE RAIKES L.AC., M.ED., MTOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAIKES
Provider First Name:
PEGGY
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.AC., M.ED., MTOM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAIKES
Provider Other First Name:
MARGARET
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.AC., M.ED., MTOM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1578729695
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
285 N EL CAMINO REAL
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
ENCINITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92024-5383
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-942-8100
Provider Business Mailing Address Fax Number:
760-942-8103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
285 N EL CAMINO REAL
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-5383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-942-8100
Provider Business Practice Location Address Fax Number:
760-942-8103
Provider Enumeration Date:
07/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC 5407 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X , with the licence number: 5407 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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