Individual
JESSICA LAINE PEATROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
670 MONTEREY PASS RD, SUITE 100, MONTEREY PARK, CA 91754-2436
(626) 551-5155
Mailing address
670 MONTEREY PASS RD, SUITE 100, MONTEREY PARK, CA 91754-2436
(626) 551-5155
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
42752
KY
208D00000X
General Practice Physician
Primary
139872
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000624958
NIS/ANTHEM
—
01
—
000026447Q
NIS/HUMANA
—
01
—
107156
SIHO/NIS
—
01
—
50025070
PHP/NIS
—
Enumeration date
03/06/2007
Last updated
02/23/2016
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