Healthcare Provider Details

I. General information

NPI: 1932396058
Provider Name (Legal Business Name): PETER GREENBERG, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR STE E218
PALM SPRINGS CA
92262-4885
US

IV. Provider business mailing address

PO BOX 575
MURRIETA CA
92564-0575
US

V. Phone/Fax

Practice location:
  • Phone: 951-691-5123
  • Fax: 951-691-5156
Mailing address:
  • Phone: 951-691-5123
  • Fax: 951-691-5156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License NumberG48958
License Number StateCA

VIII. Authorized Official

Name: DR. PETER GREENBERG
Title or Position: PRESIDENT
Credential: MD
Phone: 951-691-5123