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General NPI Number Information
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NPI Number | 1538810015
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Entity Type | Organization
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Legal Business Name | PENINSULA HEALTH CENTER LLC
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Dates
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Enumeration Date | 01/16/2022
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 655 DEEP VALLEY DR STE 325-A
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City | ROLLING HILLS ESTATES
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State | CA
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Zip | 90274-3615
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Country | US
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Telephone | 310-265-0011
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Fax | 310-265-0077
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Provider Business Mailing Address
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Address Line | 655 DEEP VALLEY DR STE 325-A
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City | ROLLING HILLS ESTATES
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State | CA
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Zip | 90274-3615
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Country | US
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Telephone | 310-265-0011
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Fax |
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Authorized Official
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Title or Position | CMO
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Name | DR. MATIN HEMMAT
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Credential | MD
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Telephone | 310-265-0011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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