Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | G48292 | CA |
NPI | 1073692927 |
---|---|
Provider Name | Dr. Peter Rees Shulman |
First Address | Encino, CA 91316-2804 |
Second Address | Encino, CA 91316-2804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G482920 | (05) | CA |