Provider Demographics
NPI:1730390329
Name:PERIDO, ELEONIDA P
Entity type:Individual
Prefix:MRS
First Name:ELEONIDA
Middle Name:P
Last Name:PERIDO
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 1:2217 CALLE BIENVENIDA
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5004
Mailing Address - Country:US
Mailing Address - Phone:909-641-2040
Mailing Address - Fax:818-500-1279
Practice Address - Street 1:1557 THE MIDWAY ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-2802
Practice Address - Country:US
Practice Address - Phone:818-500-1254
Practice Address - Fax:818-500-1279
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA464303163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse