Provider Demographics
NPI:1346940921
Name:PETERS, CORT D
Entity Type:Individual
Prefix:
First Name:CORT
Middle Name:D
Last Name:PETERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CORTPETERS INC.
Other - Middle Name:DBA
Other - Last Name:SENIOR HELPERS SAN DIEGO NORTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SH SAN DIEGO NORTH
Mailing Address - Street 1:111 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-2713
Mailing Address - Country:US
Mailing Address - Phone:442-777-7437
Mailing Address - Fax:
Practice Address - Street 1:111 N BROADWAY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-2713
Practice Address - Country:US
Practice Address - Phone:442-777-7437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374700309253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care