Individual
CARISSA PEREDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
500 W FORT ST, #111, BOISE, ID 83702-4501
(208) 422-1000
Mailing address
500 W FORT ST, #111, BOISE, ID 83702-4501
(208) 422-1000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1387
ID
Other
Enumeration date
04/26/2010
Last updated
08/02/2013
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