1912021809 NPI number — JOLENE MARIE PELOQUIN P.T.

Table of content: JOLENE MARIE PELOQUIN P.T. (NPI 1912021809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912021809 NPI number — JOLENE MARIE PELOQUIN P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PELOQUIN
Provider First Name:
JOLENE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912021809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39765 DATE ST
Provider Second Line Business Mailing Address:
STE 103
Provider Business Mailing Address City Name:
MURRIETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92563-2005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-894-4405
Provider Business Mailing Address Fax Number:
951-894-4458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39765 DATE ST
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
MURRIETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92563-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-894-4405
Provider Business Practice Location Address Fax Number:
951-894-4558
Provider Enumeration Date:
03/18/2007

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: 225100000X , with the licence number:  PT26629 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com