Provider Demographics
NPI:1841374055
Name:FISCHL, PETER (MAL)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:FISCHL
Suffix:
Gender:M
Credentials:MAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16130 KOKANEE ROAD
Mailing Address - Street 2:STE 103
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307
Mailing Address - Country:US
Mailing Address - Phone:760-242-0762
Mailing Address - Fax:760-242-0762
Practice Address - Street 1:16130 KOKANEE ROAD
Practice Address - Street 2:STE 103
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307
Practice Address - Country:US
Practice Address - Phone:760-242-0762
Practice Address - Fax:760-242-0762
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33580208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A335801Medicaid
CA020050095OtherRAILROAD MEDICARE
330324608OtherTRICARE
CA020050095OtherRAILROAD MEDICARE
CA00A335801Medicaid