Provider Demographics
NPI:1881312783
Name:PETERSON, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PETERSON
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 1:550 S WINCHESTER BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2526
Mailing Address - Country:US
Mailing Address - Phone:408-608-6820
Mailing Address - Fax:
Practice Address - Street 1:550 S WINCHESTER BLVD STE 250
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2526
Practice Address - Country:US
Practice Address - Phone:408-608-6820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator