Provider Demographics
NPI:1013235654
Name:PEFFLEY, ELISABETH M (NMD,LAC)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:M
Last Name:PEFFLEY
Suffix:
Gender:F
Credentials:NMD,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 10TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2917
Mailing Address - Country:US
Mailing Address - Phone:818-370-5153
Mailing Address - Fax:
Practice Address - Street 1:2448 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5823
Practice Address - Country:US
Practice Address - Phone:818-370-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13559171100000X
AZ14-1463208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171100000XOther Service ProvidersAcupuncturist