MEDICARE: PENINSULA HEALTH PARTNERS

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1851070189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENINSULA HEALTH PARTNERS

Provider Business Mailing Address
First Line	:	609 DEEP VALLEY DR
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3629
Country	:	US
Telephone Number	:	310-606-1349
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 DEEP VALLEY DR
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3629
Country	:	US
Telephone Number	:	310-606-1349
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	LAURA VARGAS
Credential	:
Telephone Number	:	310-606-1349

Provider Enumeration Date	:	07/13/2023
Last Update Date	:	02/11/2026

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