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General NPI Number Information
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NPI Number | 1609533280
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Entity Type | Individual
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Provider Name | MR. MICHAEL PETERS
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Gender | Male
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Dates
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Enumeration Date | 11/18/2021
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 31542 COAST HWY STE 3
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-6987
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Country | US
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Telephone | 702-203-7301
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Fax |
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Provider Business Mailing Address
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Address Line | 601 S 10TH ST # 201A
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City | LAS VEGAS
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State | NV
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Zip | 89101-7027
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Country | US
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Telephone | 702-203-7301
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Fax |
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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 | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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