Healthcare Provider Details

I. General information

NPI: 1760481907
Provider Name (Legal Business Name): PETER FOLDVARY MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 E SOUTH ST
LONG BEACH CA
90805-4521
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: PETER FOLDVARY
Title or Position: PRESIDENT
Credential: MD
Phone: 310-271-3390