Healthcare Provider Details

I. General information

NPI: 1720295918
Provider Name (Legal Business Name): MARY CATHERINE PELTIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 BAR BIT RD
SPRING VALLEY CA
91978-1901
US

IV. Provider business mailing address

9079 CALLE LUCIA
LAKESIDE CA
92040-5002
US

V. Phone/Fax

Practice location:
  • Phone: 619-337-3830
  • Fax: 619-337-3610
Mailing address:
  • Phone: 619-337-3830
  • Fax: 619-337-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: