Shannon Peterka

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

11796 Issued in CA

Practice address

7028 Hartcrest Dr
Rancho Palos Verdes, CA 90275-2936

Phone

(310) 625-7729

NPI assigned

Apr 21, 2017

Last updated

Feb 2, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517529600000",
    "number": "1033644620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7028 HARTCREST DR",
            "city": "RANCHO PALOS VERDES",
            "state": "CA",
            "postal_code": "902752936",
            "telephone_number": "310-625-7729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7028 HARTCREST DR",
            "city": "RANCHO PALOS VERDES",
            "state": "CA",
            "postal_code": "902752936",
            "telephone_number": "310-625-7729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERKA",
        "first_name": "SHANNON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-21",
        "last_updated": "2018-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": "11796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Student in an Organized Health Care Education/Training Program in Rancho Palos Verdes, CA
• Providers in Rancho Palos Verdes, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.