Healthcare Provider Details

I. General information

NPI: 1689896474
Provider Name (Legal Business Name): MARTIN LEWIS PETERS MSN, RNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 E BROADWAY SUITE 200
GLENDALE CA
91205-4927
US

IV. Provider business mailing address

27361 SIERRA HWY UNIT 314
SANTA CLARITA CA
91351-3053
US

V. Phone/Fax

Practice location:
  • Phone: 818-548-6488
  • Fax: 818-543-7305
Mailing address:
  • Phone: 661-251-7359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number298016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: