Doctor Name: | MR. THOMAS PETERSON |
NPI Number: | 1972671972 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | A26295 |
Business Practice Address: | 3628 E Imperial Hwy Suite #300 Lynwood, CA - 902622609 |
Business Phone Number: | 3109008490 |
Business Fax Number: | 3106350738 |
Mailing Address: | 17525 Ventura Blvd, Suite 203 ENCINO |
State: | CA |
Postal Code: | 913165109 |
Phone Number: | 8189860200 |
Fax Number: | 8186385762 |
NPI Enumeration Date: | 11/30/2006 |
NPI Last Update Date: | 10/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | A26295 |
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. |