Healthcare Provider Details

I. General information

NPI: 1639638679
Provider Name (Legal Business Name): LUKE CHRISTOPHER PETERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23823 VALENCIA BLVD STE 120
SANTA CLARITA CA
91355-9509
US

IV. Provider business mailing address

23823 VALENCIA BLVD STE 120
VALENCIA CA
91355-9509
US

V. Phone/Fax

Practice location:
  • Phone: 661-253-4971
  • Fax: 612-534-9726
Mailing address:
  • Phone: 612-534-9716
  • Fax: 661-253-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA179979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: