Healthcare Provider Details

I. General information

NPI: 1154615482
Provider Name (Legal Business Name): MICHAEL MARSHAL PEIKOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7040 AVENIDA ENCINAS 104-183
CARLSBAD CA
92011
US

IV. Provider business mailing address

7040 AVENIDA ENCINAS 104-183
CARLSBAD CA
92011
US

V. Phone/Fax

Practice location:
  • Phone: 702-277-1005
  • Fax: 760-448-6720
Mailing address:
  • Phone: 702-277-1005
  • Fax: 760-448-6720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG11226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: