Individual
JUSTIN D. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1250 16TH ST # C2304, SANTA MONICA, CA 90404-1249
(310) 319-4698
(310) 319-4908
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A172800
CA
208M00000X
Hospitalist Physician
Primary
A172800
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110126883A
—
MA
Enumeration date
03/21/2017
Last updated
06/30/2021
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