Individual
SARA MAE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MT(ASCP)
Contact information
Practice address
3350 LA JOLLA VILLAGE DR, SAN DIEGO, CA 92161-0002
(858) 552-8585
Mailing address
1912 EDITH DR, ESCONDIDO, CA 92026-1058
(760) 212-3181
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
MTA 43677
CA
Other
Enumeration date
08/10/2012
Last updated
08/10/2012
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