Individual
MR. PETER JOHN KIRIAKOS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
31760 CASINO DR, LAKE ELSINORE, CA 92530-2313
(951) 471-4600
(951) 471-4623
Mailing address
31760 CASINO DR, LAKE ELSINORE, CA 92530-2313
(951) 471-4600
(951) 471-4623
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0
—
CA
Enumeration date
07/22/2019
Last updated
07/22/2019
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