Provider Demographics
NPI:1467471334
Name:PEREDO, JANE (SCM)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:PEREDO
Suffix:
Gender:F
Credentials:SCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11980 NEBRASKA AVE
Mailing Address - Street 2:APT. 3
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3875
Mailing Address - Country:US
Mailing Address - Phone:310-210-4468
Mailing Address - Fax:
Practice Address - Street 1:300 MEDICAL PLZ
Practice Address - Street 2:STE. 3102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-0300
Practice Address - Fax:310-794-1290
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS