Provider Demographics
NPI:1265441216
Name:PETERS, RANDY L
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:L
Last Name:PETERS
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 1:3198 W 7TH ST APT 318
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1659
Mailing Address - Country:US
Mailing Address - Phone:213-427-2950
Mailing Address - Fax:213-427-2950
Practice Address - Street 1:3198 W 7TH ST APT 318
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1659
Practice Address - Country:US
Practice Address - Phone:213-427-2950
Practice Address - Fax:213-427-2950
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site