Dennis a Petersen D.O. Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

20A4978 Issued in CA

Legal business name

DENNIS A PETERSEN D.O. INC

Practice address

27403 Ynez Rd
Suite 103
Temecula, CA 92591-5603

Phone

(951) 506-3112

Fax

(951) 506-3116

NPI assigned

Apr 20, 2007

Organization subpart

No

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

Authorized official

Name

Dennis Alan Petersen, D.O.

Title

Doctor

Phone

(951) 506-3112

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1326265083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27403 YNEZ RD",
            "address_2": "SUITE 103",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "92591",
            "telephone_number": "951-506-3112",
            "fax_number": "951-506-3116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27403 YNEZ RD",
            "address_2": "SUITE 103",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925915603",
            "telephone_number": "951-506-3112",
            "fax_number": "951-506-3116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENNIS A PETERSEN D.O. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "951-506-3112",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "20A4978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Temecula, CA
• Providers in Temecula, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.