Provider Demographics
NPI:1346568441
Name:PETERS, MARITZA (RPH)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13521 BETSY ROSS CT
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3423
Mailing Address - Country:US
Mailing Address - Phone:909-899-0554
Mailing Address - Fax:760-246-3621
Practice Address - Street 1:14168 US HIGHWAY 395
Practice Address - Street 2:
Practice Address - City:ADELANTO
Practice Address - State:CA
Practice Address - Zip Code:92301-6700
Practice Address - Country:US
Practice Address - Phone:760-246-3524
Practice Address - Fax:760-246-3621
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist