Individual
BRADLEY S PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2612 EL CAMINITO, LA CRESCENTA, CA 91214-2963
(914) 582-1905
Mailing address
2612 EL CAMINITO, LA CRESCENTA, CA 91214-2963
(914) 582-1905
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
221893
NY
2084P0800X
Psychiatry Physician
Primary
G130737
CA
273R00000X
Psychiatric Hospital Unit
221893
NY
Other
Enumeration date
01/18/2007
Last updated
01/13/2022
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