Provider Demographics
NPI:1023156296
Name:PETERS, ANNE LOUISE (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:LOUISE
Last Name:PETERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 W OLYMPIC BLVD
Mailing Address - Street 2:#208
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4667
Mailing Address - Country:US
Mailing Address - Phone:323-936-8283
Mailing Address - Fax:323-935-2091
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:#208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4667
Practice Address - Country:US
Practice Address - Phone:323-936-8283
Practice Address - Fax:323-935-2091
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G251360Medicaid
CAA90923Medicare UPIN
CA00G251360Medicaid