Provider Demographics
NPI:1487036364
Name:PETERSEN, DANIEL S (CATC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:PETERSEN
Suffix:
Gender:M
Credentials:CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 ARNOLD DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4190
Mailing Address - Country:US
Mailing Address - Phone:925-313-9562
Mailing Address - Fax:
Practice Address - Street 1:1350 ARNOLD DR STE 102
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4190
Practice Address - Country:US
Practice Address - Phone:925-313-9562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker