Individual
MR. ERIC JOSEPH PETERS SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
629 WILSON AVE, NOVATO, CA 94947-3823
(415) 492-0818
(415) 492-0834
Mailing address
301 SMITH RANCH ROAD, SAN RAFAEL, CA 94903
(415) 492-0818
(415) 492-0834
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
P0809051024
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
N5526983
—
CA
Enumeration date
09/03/2015
Last updated
09/03/2015
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