Provider Demographics
NPI:1336785880
Name:PETERS, CATHY EILEEN
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:EILEEN
Last Name:PETERS
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 1:13956 RAVENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1784
Mailing Address - Country:US
Mailing Address - Phone:909-203-3582
Mailing Address - Fax:
Practice Address - Street 1:13956 RAVENWOOD DR
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1784
Practice Address - Country:US
Practice Address - Phone:909-203-3582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider