Provider Demographics
NPI:1598098683
Name:PEREDO, MARIA ELENA (IMFT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:PEREDO
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1896 MONACO DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3901
Mailing Address - Country:US
Mailing Address - Phone:619-742-1617
Mailing Address - Fax:
Practice Address - Street 1:6154 MISSION GORGE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3493
Practice Address - Country:US
Practice Address - Phone:619-285-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator