=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639638679
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUKE CHRISTOPHER PETERS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2019
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23823 VALENCIA BLVD STE 120
-----------------------------------------------------
City | SANTA CLARITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91355-9509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-253-4971
-----------------------------------------------------
Fax | 612-534-9726
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23823 VALENCIA BLVD STE 120
-----------------------------------------------------
City | VALENCIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91355-9509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-534-9716
-----------------------------------------------------
Fax | 661-253-4972
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A179979
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------