Healthcare Provider Details

I. General information

NPI: 1245111046
Provider Name (Legal Business Name): MRS. ELEANOR PE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10170 HUENNEKENS ST
SAN DIEGO CA
92121-2964
US

IV. Provider business mailing address

10170 HUENNEKENS ST
SAN DIEGO CA
92121-2964
US

V. Phone/Fax

Practice location:
  • Phone: 858-678-2036
  • Fax: 858-678-2036
Mailing address:
  • Phone: 858-678-2036
  • Fax: 858-678-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number545999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: