MEDICARE: DR. SHERRI PEACE M.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
1	207N00000X	Dermatology Physician	G72196	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	G72196	OTHER	CA	BLUE CROSS PROVIDER #
3	05D0966774	OTHER	CA	CLIA #
4	00G721960	OTHER	CA	BLUE SHIELD PROVIDER #

General Provider Information

NPI Number	:	1962549279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHERRI PEACE M.D.

Provider Business Mailing Address
First Line	:	8930 S SEPULVEDA BLVD
Second Line	:	SUITE 104
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3606
Country	:	US
Telephone Number	:	310-645-6001
Fax Number	:	310-645-5919

Provider Business Practice Location Address
First Line	:	8930 S SEPULVEDA BLVD
Second Line	:	SUITE 104
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3606
Country	:	US
Telephone Number	:	310-645-6001
Fax Number	:	310-645-5919

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	01/27/2025

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Directions to “ DR. SHERRI PEACE M.D.” Practice Location

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