Healthcare Provider Details

I. General information

NPI: 1760694418
Provider Name (Legal Business Name): LA PEER PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8920 WILSHIRE BLVD SUITE 620
BEVERLY HILLS CA
90211-2007
US

IV. Provider business mailing address

8920 WILSHIRE BLVD SUITE 620
BEVERLY HILLS CA
90211-2007
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-5004
  • Fax: 310-652-7195
Mailing address:
  • Phone: 310-652-5004
  • Fax: 310-652-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD A. NAGEL
Title or Position: OWNER
Credential: M.D.
Phone: 310-652-5004