Healthcare Provider Details

I. General information

NPI: 1669938320
Provider Name (Legal Business Name): KELLY PEIFFER RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N BEDFORD DR STE 105
BEVERLY HILLS CA
90210-4323
US

IV. Provider business mailing address

10982 ROEBLING AVE APT 529
LOS ANGELES CA
90024-2953
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-8590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: