Healthcare Provider Details

I. General information

NPI: 1992389373
Provider Name (Legal Business Name): ALICE PEREGRINO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3364 BEYER BLVD STE 102-103
SAN YSIDRO CA
92173-1322
US

IV. Provider business mailing address

3364 BEYER BLVD STE 102-103
SAN YSIDRO CA
92173-1322
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-4100
  • Fax:
Mailing address:
  • Phone: 619-662-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: