Provider Demographics
NPI:1780480871
Name:PEREGRINA, MAI QUETZAL
Entity type:Individual
Prefix:
First Name:MAI
Middle Name:QUETZAL
Last Name:PEREGRINA
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 1:121 S ALKI LN
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-6007
Mailing Address - Country:US
Mailing Address - Phone:360-389-6937
Mailing Address - Fax:
Practice Address - Street 1:11909 N DIVISION ST STE 102
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1969
Practice Address - Country:US
Practice Address - Phone:509-213-1442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician