Provider Demographics
NPI:1962992206
Name:TE VELDE, PAIGE MARION
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:MARION
Last Name:TE VELDE
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 1:13135 LONE STALLION LN
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-5280
Mailing Address - Country:US
Mailing Address - Phone:951-433-0954
Mailing Address - Fax:
Practice Address - Street 1:40555 CALIF OAKS RD STE 106
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5723
Practice Address - Country:US
Practice Address - Phone:951-433-0954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9452174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty