Healthcare Provider Details

I. General information

NPI: 1952887432
Provider Name (Legal Business Name): DEJA D PETERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 FRESNO ST
FRESNO CA
93721-1722
US

IV. Provider business mailing address

1519 5TH ST
CLOVIS CA
93611-1457
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-3340
  • Fax:
Mailing address:
  • Phone: 559-709-6753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: