Basic Information
| Provider Information | |||||||||
| NPI: | 1073557351 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PESHEVA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | PETROVA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 850 S ATLANTIC BLVD STE 301 | ||||||||
| Address2: | |||||||||
| City: | MONTEREY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917546710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262897699 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 850 S ATLANTIC BLVD STE 301 | ||||||||
| Address2: | |||||||||
| City: | MONTEREY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917546710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262897699 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | A88707 | CA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.