Provider Demographics
NPI:1912021809
Name:PELOQUIN, JOLENE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:MARIE
Last Name:PELOQUIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39765 DATE ST
Mailing Address - Street 2:STE 103
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2005
Mailing Address - Country:US
Mailing Address - Phone:951-894-4405
Mailing Address - Fax:951-894-4458
Practice Address - Street 1:39765 DATE ST
Practice Address - Street 2:STE 103
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2005
Practice Address - Country:US
Practice Address - Phone:951-894-4405
Practice Address - Fax:951-894-4558
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26629225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT26629AMedicare PIN