Healthcare Provider Details

I. General information

NPI: 1710370002
Provider Name (Legal Business Name): PETER J. SCHEID, M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34249 CAMINO CAPISTRANO
CAPISTRANO BEACH CA
92624-1138
US

IV. Provider business mailing address

34249 CAMINO CAPISTRANO
CAPISTRANO BEACH CA
92624-1138
US

V. Phone/Fax

Practice location:
  • Phone: 949-629-4140
  • Fax: 949-229-7684
Mailing address:
  • Phone: 949-359-5663
  • Fax: 949-542-3878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA70698
License Number StateCA

VIII. Authorized Official

Name: DR. PETER JOHN ELLIOT SCHEID
Title or Position: PRESIDENT & CEO
Credential: M.D.
Phone: 949-629-4140