Healthcare Provider Details

I. General information

NPI: 1881317352
Provider Name (Legal Business Name): IRENE PEPPER MARES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17727 E CYPRESS ST
COVINA CA
91722-2634
US

IV. Provider business mailing address

17727 E CYPRESS ST
COVINA CA
91722-2634
US

V. Phone/Fax

Practice location:
  • Phone: 626-858-4921
  • Fax:
Mailing address:
  • Phone: 626-858-4921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: