Healthcare Provider Details

I. General information

NPI: 1013734680
Provider Name (Legal Business Name): PETER DANIEL RADULESCU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 S EL CAMINO REAL STE 315
OCEANSIDE CA
92054-6390
US

IV. Provider business mailing address

2204 S EL CAMINO REAL STE 315
OCEANSIDE CA
92054-6390
US

V. Phone/Fax

Practice location:
  • Phone: 760-828-5300
  • Fax: 760-663-2054
Mailing address:
  • Phone: 760-828-5300
  • Fax: 760-663-2054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95242749
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95034627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: