Provider Demographics
NPI:1710762539
Name:VAN RIPER, PEYTON LEIGH
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:LEIGH
Last Name:VAN RIPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 ALTA LOMA RD APT 214
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2427
Mailing Address - Country:US
Mailing Address - Phone:916-687-1195
Mailing Address - Fax:
Practice Address - Street 1:10540 SHERMAN GROVE AVE
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-1913
Practice Address - Country:US
Practice Address - Phone:916-687-1195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator