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General NPI Number Information
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NPI Number | 1407043680
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Entity Type | Organization
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Legal Business Name | SHERRI PEACE, MD, INC
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 8930 S SEPULVEDA BLVD SUITE 104
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City | LOS ANGELES
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State | CA
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Zip | 90045-3606
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Country | US
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Telephone | 310-645-6001
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Fax | 310-645-5919
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Provider Business Mailing Address
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Address Line | 8930 S SEPULVEDA BLVD SUITE 104
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City | LOS ANGELES
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State | CA
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Zip | 90045-3606
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Country | US
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Telephone | 310-645-6001
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Fax | 310-645-5919
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Authorized Official
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Title or Position | PRESIDENT/MEDICAL DIRECTOR
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Name | DR. SHERRI PEACE
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Credential | MD
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Telephone | 310-645-6001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | G72196
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License Number State | CA
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