MEDICARE: NAZRA PETERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	101684	CA

General Provider Information

NPI Number	:	1477408714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAZRA PETERSON

Provider Business Mailing Address
First Line	:	6633 YUCCA APT 308
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-4105
Country	:	US
Telephone Number	:	323-251-1531
Fax Number	:

Provider Business Practice Location Address
First Line	:	6633 YUCCA STREET
Second Line	:	308
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-4105
Country	:	US
Telephone Number	:	323-251-1531
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ NAZRA PETERSON ” Practice Location

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