Provider Demographics
NPI:1174653612
Name:WALDSTEIN, PETER SOMMERS (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:SOMMERS
Last Name:WALDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N ROBERTSON BLVD
Mailing Address - Street 2:#307
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-659-8687
Mailing Address - Fax:310-659-2420
Practice Address - Street 1:150 N ROBERTSON BLVD
Practice Address - Street 2:#307
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-659-8687
Practice Address - Fax:310-659-2420
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26263208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics