Provider Demographics
NPI:1467298174
Name:PEER PROFESSIONALS OF CALIFORNIA
Entity type:Organization
Organization Name:PEER PROFESSIONALS OF CALIFORNIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TALMON
Authorized Official - Last Name:FORTE
Authorized Official - Suffix:
Authorized Official - Credentials:CPPS
Authorized Official - Phone:619-732-9772
Mailing Address - Street 1:266 LANDIS AVE APT D
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2642
Mailing Address - Country:US
Mailing Address - Phone:619-732-9972
Mailing Address - Fax:
Practice Address - Street 1:4181 RUFFIN RD STE 150
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1876
Practice Address - Country:US
Practice Address - Phone:619-292-9490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5634580OtherCOMMUNITY HEALTH WORKER
CA5634580OtherCERTIFIED PEER SUPPORT