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Individual
PETER DEAN POULLOS
Active
Individual
PETER DEAN POULLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
A73516
CA
2085R0202X
Diagnostic Radiology Physician
A73516
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A869820
—
CA
01
—
113678
UPIN
CA
Enumeration date
10/09/2007
Last updated
04/07/2024
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