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General NPI Number Information
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NPI Number | 1265648802
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Entity Type | Individual
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Provider Name | PETER FREDERICK CHKOSKI M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 07/16/2014
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Provider Practice Location Address
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Address Line | 10866 RIVERSIDE DR
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City | TOLUCA LAKE
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State | CA
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Zip | 91602-2236
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Country | US
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Telephone | 818-763-3489
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Fax | 818-763-6054
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Provider Business Mailing Address
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Address Line | 210 N TUSTIN AVE
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City | SANTA ANA
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State | CA
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Zip | 92705-3807
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Country | US
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Telephone | 714-347-1000
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Fax | 714-647-1245
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | C51414
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License Number State | CA
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