Healthcare Provider Details

I. General information

NPI: 1992389373
Provider Name (Legal Business Name): MELVA ADRIANA LLAMAS PEREGRINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 BAY BLVD STE B
CHULA VISTA CA
91911-2670
US

IV. Provider business mailing address

1161 BAY BLVD STE B
CHULA VISTA CA
91911-2670
US

V. Phone/Fax

Practice location:
  • Phone: 619-585-7686
  • Fax:
Mailing address:
  • Phone: 619-585-7686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health 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: