Doctor Name: | DR. KELSEY CARL PETERSON |
NPI Number: | 1033281019 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | G17592 |
Business Practice Address: | 17742 Beach Blvd 245 Huntington Beach, CA - 926476818 |
Business Phone Number: | 7143290179 |
Business Fax Number: | 7149650311 |
Mailing Address: | 20462 Kenworth Cir, HUNTINGTON BEACH |
State: | CA |
Postal Code: | 926465446 |
Phone Number: | 7143290179 |
Fax Number: | 7149650311 |
NPI Enumeration Date: | 11/14/2006 |
NPI Last Update Date: | 03/15/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | G17592 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |