Healthcare Provider Details

I. General information

NPI: 1033013214
Provider Name (Legal Business Name): SILAS PEABODY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9620 CHESAPEAKE DR STE 105
SAN DIEGO CA
92123-1324
US

IV. Provider business mailing address

9240 CARTHAY CIR
SPRING VALLEY CA
91977-1123
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: