MEDICARE: MRS. ELEANOR PE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	545999	CA

General Provider Information

NPI Number	:	1245111046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELEANOR PE

Provider Business Mailing Address
First Line	:	10170 HUENNEKENS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-2964
Country	:	US
Telephone Number	:	858-678-2036
Fax Number	:	858-678-2036

Provider Business Practice Location Address
First Line	:	10170 HUENNEKENS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-2964
Country	:	US
Telephone Number	:	858-678-2036
Fax Number	:	858-678-2036

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2025
Last Update Date	:	09/09/2025

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