Provider Demographics
NPI:1023153277
Name:PETER HELTON PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:PETER HELTON PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:HELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-646-3376
Mailing Address - Street 1:1901 WESTCLIFF DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5598
Mailing Address - Country:US
Mailing Address - Phone:949-646-3376
Mailing Address - Fax:
Practice Address - Street 1:1901 WESTCLIFF DR
Practice Address - Street 2:2
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5598
Practice Address - Country:US
Practice Address - Phone:949-646-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6853207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20A6853BMedicare PIN
CA20A6853Medicare ID - Type Unspecified
CAF49090Medicare UPIN