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General NPI Number Information
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NPI Number | 1407925209
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Entity Type | Individual
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Provider Name | REGINALD R PETERS P.A.
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Gender | Male
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2499 E LAKESHORE DR
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-4411
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Country | US
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Telephone | 951-471-4200
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Fax | 951-471-4205
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Provider Business Mailing Address
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Address Line | 4065 COUNTY CIRCLE DR ROOM 309
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City | RIVERSIDE
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State | CA
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Zip | 92503-3410
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Country | US
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Telephone | 951-358-5222
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Fax | 951-358-5235
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA18227
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License Number State | CA
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