Provider Demographics
NPI:1962276139
Name:PIGRUM-MOREAU, PERTRINA MARIE
Entity type:Individual
Prefix:
First Name:PERTRINA
Middle Name:MARIE
Last Name:PIGRUM-MOREAU
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 1:100 HARRIS CIR
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-3506
Mailing Address - Country:US
Mailing Address - Phone:925-597-4891
Mailing Address - Fax:
Practice Address - Street 1:4350 PALO VERDE DR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-6332
Practice Address - Country:US
Practice Address - Phone:925-252-1571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health