Healthcare Provider Details

I. General information

NPI: 1851162705
Provider Name (Legal Business Name): ANGELICA PEREDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 S EL CAMINO REAL
SAN MATEO CA
94402-2804
US

IV. Provider business mailing address

1108 S EL CAMINO REAL
SAN MATEO CA
94402-2804
US

V. Phone/Fax

Practice location:
  • Phone: 650-679-3127
  • Fax:
Mailing address:
  • Phone: 650-679-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: