MEDICARE: JANE PEREDO SCM

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1467471334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE PEREDO SCM

Provider Business Mailing Address
First Line	:	11980 NEBRASKA AVE
Second Line	:	APT. 3
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3875
Country	:	US
Telephone Number	:	310-210-4468
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 MEDICAL PLZ
Second Line	:	STE. 3102
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-0001
Country	:	US
Telephone Number	:	310-825-0300
Fax Number	:	310-794-1290

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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