Healthcare Provider Details

I. General information

NPI: 1780651828
Provider Name (Legal Business Name): KARIN S PETERSON MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARIN SEGE-PETERSON

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8110 BIRMINGHAM WAY BLDG 28
SAN DIEGO CA
92123-2758
US

IV. Provider business mailing address

3860 CALLE FORTUNADA STE #210
SAN DIEGO CA
92123-4802
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-5961
  • Fax: 858-966-6791
Mailing address:
  • Phone: 858-309-6303
  • Fax: 858-309-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA52621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: