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General NPI Number Information
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NPI Number | 1073663886
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Entity Type | Individual
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Provider Name | PETERSON PIERRE MD
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 77 E. ROLLING OAKS DRIVE, SUITE 207
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City | THOUSAND OAKS
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State | CA
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Zip | 91361
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Country | US
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Telephone | 805-496-9190
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Fax | 805-496-9185
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Provider Business Mailing Address
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Address Line | 77 E. ROLLING OAKS DRIVE, SUITE 207
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City | THOUSAND OAKS
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State | CA
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Zip | 91361
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Country | US
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Telephone | 805-496-9190
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Fax | 805-496-9185
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A66363
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License Number State | CA
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