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General NPI Number Information
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NPI Number | 1750618021
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Entity Type | Individual
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Provider Name | JENNIFER DOROTHEA PETERS FNP
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Gender | Female
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Dates
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Enumeration Date | 11/07/2009
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Last Update Date | 11/07/2009
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Provider Practice Location Address
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Address Line | 3350 LA JOLLA VILLAGE DR
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City | SAN DIEGO
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State | CA
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Zip | 92161-0002
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Country | US
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Telephone | 909-435-5019
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7102
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City | REDLANDS
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State | CA
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Zip | 92375-0102
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Country | US
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Telephone | 909-435-5019
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 17826
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 663212
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License Number State | CA
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