Provider Demographics
NPI:1518048370
Name:PETER L. KARLSBERG, M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PETER L. KARLSBERG, M.D. A MEDICAL CORPORATION
Other - Org Name:THE CENTER FOR RESTORATIVE DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:KARLSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-677-1600
Mailing Address - Street 1:1190 S VICTORIA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6545
Mailing Address - Country:US
Mailing Address - Phone:805-677-1601
Mailing Address - Fax:
Practice Address - Street 1:1190 S VICTORIA AVE STE 300
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6545
Practice Address - Country:US
Practice Address - Phone:805-677-1600
Practice Address - Fax:805-677-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80832174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18670Medicare ID - Type UnspecifiedPROVIDER NUMBER
CAG04306Medicare UPIN