Provider Demographics
NPI:1336120070
Name:BRESLER, PETER A (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:BRESLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:A
Other - Last Name:BRESLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:328 TRAVIS DR
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-4330
Mailing Address - Country:US
Mailing Address - Phone:805-801-4607
Mailing Address - Fax:805-528-1120
Practice Address - Street 1:328 TRAVIS DR
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-4330
Practice Address - Country:US
Practice Address - Phone:805-801-4607
Practice Address - Fax:805-528-1120
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42463Medicare UPIN