Provider Demographics
NPI:1316584907
Name:PEREIDA, CHRISTOPHER TIMOTHY (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:TIMOTHY
Last Name:PEREIDA
Suffix:
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W AVENUE L
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-7211
Mailing Address - Country:US
Mailing Address - Phone:661-723-6884
Mailing Address - Fax:
Practice Address - Street 1:1600 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2814
Practice Address - Country:US
Practice Address - Phone:661-726-6225
Practice Address - Fax:661-949-5191
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
CANP95012512363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty