Provider Demographics
NPI:1689230450
Name:PETERSON, NICHOLAS EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:EDWARD
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:612 ANACAPA ST APT A
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1653
Mailing Address - Country:US
Mailing Address - Phone:805-272-0020
Mailing Address - Fax:
Practice Address - Street 1:401 CHAPALA ST STE 102
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3496
Practice Address - Country:US
Practice Address - Phone:805-272-0020
Practice Address - Fax:651-666-1610
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1853512081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine