Healthcare Provider Details

I. General information

NPI: 1427257864
Provider Name (Legal Business Name): PETER GELBER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 FLYNN RD
CAMARILLO CA
93012-8704
US

IV. Provider business mailing address

975 FLYNN RD
CAMARILLO CA
93012-8704
US

V. Phone/Fax

Practice location:
  • Phone: 805-388-7740
  • Fax: 805-482-0987
Mailing address:
  • Phone: 805-388-7740
  • Fax: 805-482-0987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: