Healthcare Provider Details

I. General information

NPI: 1881312783
Provider Name (Legal Business Name): LAURA PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S WINCHESTER BLVD STE 250
SAN JOSE CA
95128-2526
US

IV. Provider business mailing address

550 S WINCHESTER BLVD STE 250
SAN JOSE CA
95128-2526
US

V. Phone/Fax

Practice location:
  • Phone: 408-608-6820
  • Fax:
Mailing address:
  • Phone: 408-608-6820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: