Provider Demographics
NPI:1629137062
Name:PETERSEN, KARLA MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:MELISSA
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1721 SCOTT ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3034
Mailing Address - Country:US
Mailing Address - Phone:415-287-6499
Mailing Address - Fax:415-287-6597
Practice Address - Street 1:1721 SCOTT ST STE 3A
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3034
Practice Address - Country:US
Practice Address - Phone:415-287-6499
Practice Address - Fax:415-287-6597
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA797872084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry