Healthcare Provider Details

I. General information

NPI: 1629548441
Provider Name (Legal Business Name): DARENESHA EVETTE PETERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8424 HOOPER AVE
LOS ANGELES CA
90001-3741
US

IV. Provider business mailing address

1205 E 84TH PL
LOS ANGELES CA
90001-3723
US

V. Phone/Fax

Practice location:
  • Phone: 323-798-6250
  • Fax:
Mailing address:
  • Phone: 760-269-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: