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NPI Code Detail

MEDICARE: DR. STEFANIE DOYLE PETERS PH.D.

MEDICARE: DR. STEFANIE DOYLE PETERS PH.D.
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
1103TC0700XClinical PsychologistPSY9578CA

General Provider Information

NPI Number : 1558690354
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEFANIE DOYLE PETERS PH.D.
Provider Business Mailing Address
First Line : 3415 S SEPULVEDA BLVD
Second Line : STE 1100
City : LOS ANGELES
State : CA
Zip : 90034-7090
Country : US
Telephone Number : 310-204-6250
Fax Number : 310-204-6250
Provider Business Practice Location Address
First Line : 3415 S SEPULVEDA BLVD
Second Line : STE 1100
City : LOS ANGELES
State : CA
Zip : 90034-7090
Country : US
Telephone Number : 310-204-6250
Fax Number : 310-204-6250
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2009
Last Update Date : 06/02/2020

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