Healthcare Provider Details

I. General information

NPI: 1043524630
Provider Name (Legal Business Name): CALVIN T PETERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 FOUNTAIN AVE
LOS ANGELES CA
90029-1005
US

IV. Provider business mailing address

6071 W OUTER DR
DETROIT MI
48235-2624
US

V. Phone/Fax

Practice location:
  • Phone: 323-461-9961
  • Fax:
Mailing address:
  • Phone: 313-966-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA138038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: