Provider Demographics
NPI:1972335776
Name:PEREDO, JUDDITH ALDAN
Entity type:Individual
Prefix:
First Name:JUDDITH
Middle Name:ALDAN
Last Name:PEREDO
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 1:134 CHALAN EMSLEY
Mailing Address - Street 2:
Mailing Address - City:YIGO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-4710
Mailing Address - Country:US
Mailing Address - Phone:671-685-0574
Mailing Address - Fax:
Practice Address - Street 1:134 CHALAN EMSLEY
Practice Address - Street 2:
Practice Address - City:YIGO
Practice Address - State:GU
Practice Address - Zip Code:96929-4710
Practice Address - Country:US
Practice Address - Phone:671-685-0574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider