Basic Information
| Provider Information | |||||||||
| NPI: | 1235171299 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETERSON | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 263 N LINDA VISTA AVE | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930012311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056433101 | ||||||||
| FaxNumber: | 8056432828 | ||||||||
| Practice Location | |||||||||
| Address1: | 2895 LOMA VISTA RD | ||||||||
| Address2: | SUITE #E | ||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930031572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056432895 | ||||||||
| FaxNumber: | 8056432828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G064562 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.