Healthcare Provider Details

I. General information

NPI: 1386165777
Provider Name (Legal Business Name): PETER S WALDSTEIN MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N ROBERTSON BLVD STE 307
BEVERLY HILLS CA
90211-2145
US

IV. Provider business mailing address

150 N ROBERTSON BLVD STE 307
BEVERLY HILLS CA
90211-2145
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 Number
License Number State

VIII. Authorized Official

Name: DR. PETER SOMMERS WALDSTEIN
Title or Position: PRESIDENT
Credential:
Phone: 310-659-8687