Basic Information
| Provider Information | |||||||||
| NPI: | 1043265580 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CZULEGER | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 26800 CROWN VALLEY PKWY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926916365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492762111 | ||||||||
| FaxNumber: | 9492762115 | ||||||||
| Practice Location | |||||||||
| Address1: | 26800 CROWN VALLEY PKWY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926916365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492762111 | ||||||||
| FaxNumber: | 9492762115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 10/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | A34446 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 050618CA27480 | 01 | CA | BEAR VALLEY TRAILBLAZER | OTHER | 00A344460 | 01 | CA | BLUE SHIELD | OTHER | 00A344460 | 01 | CA | CALOPTIMA | OTHER | A34446 | 01 | CA | BLUE CROSS | OTHER | 00A344460 | 05 | CA | MEDICAID |