Provider Demographics
NPI:1780651828
Name:PETERSON, KARIN S (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KARIN
Middle Name:S
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:
Other - Last Name:SEGE-PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3860 CALLE FORTUNADA
Mailing Address - Street 2:STE #210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4802
Mailing Address - Country:US
Mailing Address - Phone:858-309-6303
Mailing Address - Fax:858-309-6301
Practice Address - Street 1:8110 BIRMINGHAM WAY
Practice Address - Street 2:BLDG 28
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2758
Practice Address - Country:US
Practice Address - Phone:858-966-5961
Practice Address - Fax:858-966-6791
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52621207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A526210Medicaid