Provider Demographics
NPI:1720124530
Name:PERIDON SANDRO, UNIQUE ANJEANETTE (DEPUTY PROBATION OFF)
Entity Type:Individual
Prefix:MRS
First Name:UNIQUE
Middle Name:ANJEANETTE
Last Name:PERIDON SANDRO
Suffix:
Gender:F
Credentials:DEPUTY PROBATION OFF
Other - Prefix:MRS
Other - First Name:UNIQUE
Other - Middle Name:ANGIE
Other - Last Name:PERIDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPOII
Mailing Address - Street 1:42 COUNTY CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965
Mailing Address - Country:US
Mailing Address - Phone:530-345-3651
Mailing Address - Fax:
Practice Address - Street 1:5910 CLARK ROAD
Practice Address - Street 2:SUITE H & I
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969
Practice Address - Country:US
Practice Address - Phone:530-872-6325
Practice Address - Fax:530-872-5970
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor