Provider Demographics
NPI:1427212034
Name:PETERS, AMY CHRISTINE MARQUARDT (DO)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTINE MARQUARDT
Last Name:PETERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24411 HEALTH CENTER DR STE 640
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3633
Mailing Address - Country:US
Mailing Address - Phone:949-770-4115
Mailing Address - Fax:949-770-3422
Practice Address - Street 1:24411 HEALTH CENTER DR STE 640
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3633
Practice Address - Country:US
Practice Address - Phone:949-770-4115
Practice Address - Fax:949-770-3422
Is Sole Proprietor?:No
Enumeration Date:2008-07-12
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017746207V00000X
IL036.129906207V00000X
CA20A13720207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology