Healthcare Provider Details

I. General information

NPI: 1245635515
Provider Name (Legal Business Name): SALISHA PETERS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 PASEO AZUL WAY
CORONA CA
92879-8503
US

IV. Provider business mailing address

1253 PASEO AZUL WAY
CORONA CA
92879-8503
US

V. Phone/Fax

Practice location:
  • Phone: 951-710-0033
  • Fax:
Mailing address:
  • Phone: 951-710-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number640665
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number640665
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number640665
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number640665
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number640665
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number640665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: