Individual
JAYME L PETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3230 KERNER BLVD, SAN RAFAEL, CA 94901-4840
(415) 473-2611
Mailing address
3230 KERNER BLVD, SAN RAFAEL, CA 94901-4840
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
29934
CA
Other
Enumeration date
07/29/2013
Last updated
03/12/2018
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