Provider Demographics
NPI:1023467537
Name:ACHENBACH, PETER RICHARD
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:RICHARD
Last Name:ACHENBACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6194 CARDINAL ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6512
Mailing Address - Country:US
Mailing Address - Phone:805-896-3635
Mailing Address - Fax:
Practice Address - Street 1:6194 CARDINAL ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6512
Practice Address - Country:US
Practice Address - Phone:805-896-3635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program