Organization
BRADLEY M. PETERSON, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY MORRIS PETERSON M.D. (PRESIDENT)
(858) 966-5863
Entity
Organization
Contact information
Practice address
3030 CHILDRENS WAY, #115, SAN DIEGO, CA 92123-4232
(858) 966-5863
(858) 279-8415
Mailing address
3030 CHILDRENS WAY, #115, SAN DIEGO, CA 92123-4232
(858) 966-5863
(858) 279-8415
Taxonomy
Speciality
Code
Description
License number
State
207LP3000X
Pediatric Anesthesiology Physician
Primary
G21961
CA
2080P0203X
Pediatric Critical Care Medicine Physician
G21961
CA
Other
Enumeration date
02/24/2014
Last updated
02/24/2014
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