Healthcare Provider Details

I. General information

NPI: 1063608941
Provider Name (Legal Business Name): PEGGY MIONE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 06/14/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9758 RAVARI DR
CYPRESS CA
90630-3551
US

IV. Provider business mailing address

21946 SAGEBRUSH CIR
LAKE FOREST CA
92630-2728
US

V. Phone/Fax

Practice location:
  • Phone: 714-220-0225
  • Fax:
Mailing address:
  • Phone: 949-916-4396
  • Fax: 949-916-6289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number653137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: