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General NPI Number Information
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NPI Number | 1194944090
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Entity Type | Individual
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Provider Name | KATHLEEN MAY PEREGOY RDA
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Gender | Female
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1425 MONTGOMERY RD
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City | RED BLUFF
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State | CA
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Zip | 96080-4605
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Country | US
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Telephone | 530-528-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 9330 SAN BENITO AVE
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City | GERBER
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State | CA
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Zip | 96035-9701
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Country | US
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Telephone | 530-385-1190
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 39486
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License Number State | CA
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