MEDICARE: JESSICA LAINE PEATROSS MD

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	207R00000X	Internal Medicine Physician	42752	KY
2	208D00000X	General Practice Physician	139872	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	107156	OTHER	SIHO/NIS
2	000000624958	OTHER	NIS/ANTHEM
3	000026447Q	OTHER	NIS/HUMANA
4	50025070	OTHER	PHP/NIS

General Provider Information

NPI Number	:	1689704074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LAINE PEATROSS MD

Provider Business Mailing Address
First Line	:	670 MONTEREY PASS RD
Second Line	:	SUITE 100
City	:	MONTEREY PARK
State	:	CA
Zip	:	91754-2436
Country	:	US
Telephone Number	:	626-551-5155
Fax Number	:

Provider Business Practice Location Address
First Line	:	670 MONTEREY PASS RD
Second Line	:	SUITE 100
City	:	MONTEREY PARK
State	:	CA
Zip	:	91754-2436
Country	:	US
Telephone Number	:	626-551-5155
Fax Number	:

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	02/23/2016

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Directions to “ JESSICA LAINE PEATROSS MD” Practice Location

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