Healthcare Provider Details

I. General information

NPI: 1013126143
Provider Name (Legal Business Name): PETER F. AFSARI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 MURRAY AVE STE 220
SAN LUIS OBISPO CA
93405-2058
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1928
US

V. Phone/Fax

Practice location:
  • Phone: 805-250-2996
  • Fax: 805-250-2998
Mailing address:
  • Phone: 916-576-7898
  • Fax: 916-285-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20A12976
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A12976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: