Provider Demographics
NPI:1740639301
Name:PEREGRINO, CAROLAIN SUZUKI
Entity type:Individual
Prefix:
First Name:CAROLAIN
Middle Name:SUZUKI
Last Name:PEREGRINO
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 1:2542 S BASCOM AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-5526
Mailing Address - Country:US
Mailing Address - Phone:408-559-3403
Mailing Address - Fax:
Practice Address - Street 1:2542 S BASCOM AVE
Practice Address - Street 2:STE 110
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-5526
Practice Address - Country:US
Practice Address - Phone:408-559-3403
Practice Address - Fax:408-559-3158
Is Sole Proprietor?:No
Enumeration Date:2016-06-05
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004196363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health