Provider Demographics
NPI:1013386804
Name:R. PETERSON ACUPUNCTURE, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:R. PETERSON ACUPUNCTURE, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:619-602-1163
Mailing Address - Street 1:6986 EL CAMINO REAL
Mailing Address - Street 2:SUITE F
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4109
Mailing Address - Country:US
Mailing Address - Phone:760-438-9548
Mailing Address - Fax:760-438-1603
Practice Address - Street 1:6986 EL CAMINO REAL
Practice Address - Street 2:SUITE F
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-4109
Practice Address - Country:US
Practice Address - Phone:760-438-9548
Practice Address - Fax:760-438-1603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty