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General NPI Number Information
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NPI Number | 1912971615
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Entity Type | Individual
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Provider Name | KARL A PETERSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/17/2006
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 2200 FOOTHILL BLVD
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City | LA CANADA
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State | CA
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Zip | 91011-1413
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Country | US
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Telephone | 818-790-1103
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Fax | 818-949-4981
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Provider Business Mailing Address
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Address Line | 10101 ORCAS AVE
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City | SUNLAND
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State | CA
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Zip | 91040-1380
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Country | US
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Telephone | 818-381-2573
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Fax | 818-949-4981
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G80642
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License Number State | CA
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