Healthcare Provider Details

I. General information

NPI: 1174653612
Provider Name (Legal Business Name): PETER SOMMERS WALDSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N ROBERTSON BLVD #307
BEVERLY HILLS CA
90210
US

IV. Provider business mailing address

150 N ROBERTSON BLVD #307
BEVERLY HILLS CA
90210
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-8687
  • Fax: 310-659-2420
Mailing address:
  • Phone: 310-659-8687
  • Fax: 310-659-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA26263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: