Provider Demographics
NPI:1730625054
Name:PEREIDA, ARLENE
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:PEREIDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ARLENE
Other - Middle Name:
Other - Last Name:MCROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 14932
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-4932
Mailing Address - Country:US
Mailing Address - Phone:805-458-1127
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SLO
Practice Address - State:CA
Practice Address - Zip Code:93409
Practice Address - Country:US
Practice Address - Phone:805-547-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAT-4088225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist