Healthcare Provider Details

I. General information

NPI: 1457414492
Provider Name (Legal Business Name): MAXIMUS JOHANNES PEPERKAMP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 RIO LINDO AVENUE
CHICO CA
95926
US

IV. Provider business mailing address

1215 PENINSULA DRIVE
CHICO CA
95928
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-2775
  • Fax: 530-895-6547
Mailing address:
  • Phone: 530-892-8474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: