Healthcare Provider Details

I. General information

NPI: 1760666978
Provider Name (Legal Business Name): PEGGY JEU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 01/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BEACH BLVD
ANAHEIM CA
92804-1810
US

IV. Provider business mailing address

3939 E ALLIN ST #314
LONG BEACH CA
90803-2863
US

V. Phone/Fax

Practice location:
  • Phone: 714-816-0540
  • Fax:
Mailing address:
  • Phone: 562-433-0018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: