Healthcare Provider Details

I. General information

NPI: 1407471410
Provider Name (Legal Business Name): JOYCE PETERS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9465 WILSHIRE BLVD STE 300
BEVERLY HILLS CA
90212-2624
US

IV. Provider business mailing address

9818 WANDA PARK DR
BEVERLY HILLS CA
90210-1431
US

V. Phone/Fax

Practice location:
  • Phone: 424-324-9339
  • Fax:
Mailing address:
  • Phone: 424-324-9339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number202362
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number202362
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number202362
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number202362
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1147
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number52070
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code261QG0250X
TaxonomyGenetics Clinic/Center
License Number202362
License Number StateAL
# 8
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number202362
License Number StateAL
# 9
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number202362
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: