Individual
PETER LAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
36320 INLAND VALLEY DR STE 308, WILDOMAR, CA 92595-7512
(951) 600-7630
(951) 600-7164
Mailing address
3660 PARK SIERRA DR STE 203, RIVERSIDE, CA 92505-3071
(951) 687-3400
(951) 687-7630
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A91135
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A91135
LIC
CA
Enumeration date
07/25/2006
Last updated
08/10/2021
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