Basic Information
| Provider Information | |||||||||
| NPI: | 1730215963 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETERS | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | N.P.B.S.N,M.S.N | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7549 HILLMONT DR | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946052931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105629628 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 830 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947102044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109815350 | ||||||||
| FaxNumber: | 5109816385 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0005X | 279429 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Family Planning Facility |
No ID Information.