Healthcare Provider Details

I. General information

NPI: 1912709882
Provider Name (Legal Business Name): PETER LLAMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 E STEARNS ST STE 107-126
LONG BEACH CA
90815-3100
US

IV. Provider business mailing address

5555 E STEARNS ST STE 107-126
LONG BEACH CA
90815-3100
US

V. Phone/Fax

Practice location:
  • Phone: 562-739-4612
  • Fax:
Mailing address:
  • Phone: 562-739-4612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: