| Jon Peterson,phd | |
|
25401 Cabot Rd Suite 213 Laguna Hills CA 92653-5524 | |
| (949) 363-7386 | |
| (949) 276-2199 |
| Full Name | Jon Peterson,phd |
|---|---|
| Speciality | Clinic/Center |
| Location | 25401 Cabot Rd, Laguna Hills, California |
| Authorized Official Name and Position | Jon W Peterson (OWNER) |
| Authorized Official Contact | 9493637386 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jon Peterson,phd 25401 Cabot Rd Suite 213 Laguna Hills CA 92653-5524 Ph: (949) 363-7386 | Jon Peterson,phd 25401 Cabot Rd Suite 213 Laguna Hills CA 92653-5524 Ph: (949) 363-7386 |
| NPI Number | 1396983128 |
|---|---|
| Provider Enumeration Date | 02/02/2009 |
| Last Update Date | 02/02/2009 |
| Medicare PECOS PAC ID | 8426118845 |
|---|---|
| Medicare Enrollment ID | O20090331000307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396983128 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | PSY6987 (California) | Primary |
| Provider Name | Jon W Peterson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972549236 PECOS PAC ID: 5092873687 Enrollment ID: I20090331000293 |
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