Provider Demographics
NPI:1821252719
Name:PETERS, CAROL L
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5294 LIVERING LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3230
Mailing Address - Country:US
Mailing Address - Phone:858-715-1285
Mailing Address - Fax:
Practice Address - Street 1:4080 CENTRE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2655
Practice Address - Country:US
Practice Address - Phone:619-543-9850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program