Basic Information
| Provider Information | |||||||||
| NPI: | 1669613816 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETERSON | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | CURTIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7001 | ||||||||
| Address2: | |||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913577001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188887815 | ||||||||
| FaxNumber: | 3233807420 | ||||||||
| Practice Location | |||||||||
| Address1: | 3209 HILLOCK DR | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900681427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102663774 | ||||||||
| FaxNumber: | 3233807420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2009 | ||||||||
| LastUpdateDate: | 02/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A103097 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 2084A0401X | A103097 | CA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 207LP2900X | A103097 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.