Provider Demographics
NPI:1831269059
Name:VASH, PETER DESIDER (MD MPH)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:DESIDER
Last Name:VASH
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK EAST
Mailing Address - Street 2:SUITE 1511
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067
Mailing Address - Country:US
Mailing Address - Phone:310-553-0804
Mailing Address - Fax:310-553-9459
Practice Address - Street 1:2080 CENTURY PARK EAST
Practice Address - Street 2:SUITE 1511
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067
Practice Address - Country:US
Practice Address - Phone:310-553-0804
Practice Address - Fax:310-553-9459
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA625397207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0559285OtherCLIA
CA05D0559285OtherCLIA
CAAV6843901OtherDEA
CAA42649Medicare UPIN