Healthcare Provider Details

I. General information

NPI: 1851867758
Provider Name (Legal Business Name): PETER STOOPS D.O. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13312 RANCHERO RD STE 16
OAK HILLS CA
92344-4802
US

IV. Provider business mailing address

13312 RANCHERO RD STE 16
OAK HILLS CA
92344-4802
US

V. Phone/Fax

Practice location:
  • Phone: 760-948-0132
  • Fax: 760-357-0357
Mailing address:
  • Phone: 760-948-0132
  • Fax: 760-357-0357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PETER STOOPS
Title or Position: CEO
Credential: DO
Phone: 760-948-0132