Healthcare Provider Details

I. General information

NPI: 1528067170
Provider Name (Legal Business Name): PETER FOLDVARY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2005
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date: 07/18/2005
Reactivation Date: 06/19/2007

III. Provider practice location address

3715 SOUTH ST
LONG BEACH CA
90805
US

IV. Provider business mailing address

PO BOX 16580
BEVERLY HILLS CA
90209-2580
US

V. Phone/Fax

Practice location:
  • Phone: 310-271-3390
  • Fax:
Mailing address:
  • Phone: 310-271-3390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG32026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: