Provider Demographics
NPI:1255802195
Name:PEREDA, MARIE C
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:C
Last Name:PEREDA
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 1:200 MILL AVE S STE 10
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2175
Mailing Address - Country:US
Mailing Address - Phone:425-282-0341
Mailing Address - Fax:
Practice Address - Street 1:200 MILL AVE S STE 10
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2175
Practice Address - Country:US
Practice Address - Phone:425-282-0341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator