Provider Demographics
NPI:1215604046
Name:MOUTTAPA, PETER G (MSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:G
Last Name:MOUTTAPA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:MR
Other - First Name:PETER
Other - Middle Name:G
Other - Last Name:MOUTTAPA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:160 E. VIRGINIA ST. SUITE 100
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5817
Mailing Address - Country:US
Mailing Address - Phone:408-938-2113
Mailing Address - Fax:408-579-6143
Practice Address - Street 1:160 E. VIRGINIA ST. SUITE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5817
Practice Address - Country:US
Practice Address - Phone:408-938-2113
Practice Address - Fax:408-579-6143
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-28
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health