Individual
DR. PEOLIA KANSAS FONSWORTH III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., M.B.A
Contact information
Practice address
1000 W CARSON ST, TORRANCE, CA 90502-2004
(310) 222-2345
Mailing address
1000 W CARSON ST, TORRANCE, CA 90502-2004
(415) 240-5467
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
A132680
CA
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
A132680
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/03/2013
Last updated
06/21/2023
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