Provider Demographics
NPI:1578729695
Name:RAIKES, PEGGY ANNE (LAC, MED, MTOM)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:ANNE
Last Name:RAIKES
Suffix:
Gender:F
Credentials:LAC, MED, MTOM
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:ANNE
Other - Last Name:RAIKES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, MED, MTOM
Mailing Address - Street 1:285 N EL CAMINO REAL
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5383
Mailing Address - Country:US
Mailing Address - Phone:760-942-8100
Mailing Address - Fax:760-942-8103
Practice Address - Street 1:285 N EL CAMINO REAL
Practice Address - Street 2:SUITE 211
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5383
Practice Address - Country:US
Practice Address - Phone:760-942-8100
Practice Address - Fax:760-942-8103
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 5407171100000X
CA5407171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist