Provider Demographics
NPI:1548388549
Name:PERGEAUX, KATRINA S (LAC)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:S
Last Name:PERGEAUX
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6536 SWEET MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433
Mailing Address - Country:US
Mailing Address - Phone:561-400-6006
Mailing Address - Fax:
Practice Address - Street 1:6536 SWEET MAPLE LN
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:561-400-6006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist