Provider Demographics
NPI:1407471410
Name:PETERS, JOYCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9818 WANDA PARK DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-1431
Mailing Address - Country:US
Mailing Address - Phone:424-324-9339
Mailing Address - Fax:
Practice Address - Street 1:9465 WILSHIRE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2624
Practice Address - Country:US
Practice Address - Phone:424-324-9339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL202362133NN1002X, 175F00000X, 207N00000X, 207Q00000X, 261QG0250X, 261QR1100X, 261QM1300X
AL1147225700000X
CA52070225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No175F00000XOther Service ProvidersNaturopath
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52070OtherCALIFORNIA THERAPY BOARD
AL1147OtherALABAMA BOARD OF PHYSICAL MASSAGE THERAPY
AL4978927OtherSTATE LICENSE NUMBER
AL202362OtherALABAMA STATE
AL202362OtherSTATE LICENSING BOARD OCCUPATION MEDICINE