BRADLEY M. PETERSON, M.D., INC. (NPI# 1952726242) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952726242 |
| Entity Type | Organization |
| Organization Name | BRADLEY M. PETERSON, M.D., INC. |
| Practice Address |
3030 Childrens Way #115 San Diego CA 92123-4232 |
| Practice Telephone | 8589665863 |
| Practice Fax Number | 8582798415 |
| Mailing Telephone | 8589665863 |
| Mailing Fax Number | 8582798415 |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2014-02-24 |
| Authorized Official Name | DR. BRADLEY MORRIS PETERSON (PRESIDENT) |
| Authorized Official Telephone | 8589665863 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
G21961 | CA | Allopathic & Osteopathic Physicians |
| Y | 207LP3000X |
Anesthesiology Specialization: Pediatric Anesthesiology |
G21961 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
3030 CHILDRENS WAY #115 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92123-4232 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144229600 | Charles Douglas Wallace | Orthopaedic Surgery | 3030 Childrens Way, Ste 410, San Diego, CA 92123-4232 | 2005-07-18 |
| 1841808854 | Lorri A. Kais | Clinical Neuropsychologist | 3030 Childrens Way, San Diego, CA 92123-4232 | 2020-07-15 |
| 1114541760 | Samantha Barbara Nigrelli | Nurse Practitioner | 3030 Childrens Way, San Diego, CA 92123-4232 | 2020-05-29 |
| 1134755630 | Sara J. Fligelman | Psychologist | 3030 Childrens Way, San Diego, CA 92123-4232 | 2020-03-16 |
| 1316571367 | Kayleigh M. Prowse | Nurse Practitioner | 3030 Childrens Way, San Diego, CA 92123-4232 | 2020-02-28 |
| 1639649239 | Kimberly Charlotte Padilla | Nurse Practitioner | 3030 Childrens Way, San Diego, CA 92123 | 2018-11-27 |
| 1568953172 | Elizabeth Williams Smith | Nurse Practitioner | 3030 Childrens Way, San Diego, CA 92123-4232 | 2018-05-21 |
| 1083132260 | Eve U. Nguyen | Psychologist | 3030 Childrens Way, San Diego, CA 92123-4232 | 2017-09-07 |
| 1659893295 | Ronak Rahmanian | Otolaryngology | 3030 Childrens Way, San Diego, CA 92123-4232 | 2017-07-14 |
| 1689048530 | Carie Truong Lam | Physician Assistant | 3030 Childrens Way, San Diego, CA 92123-4232 | 2015-11-16 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669087326 | Corina Lozano Manzo | Registered Nurse | 7436 Mission Center Road, San Diego, CA 92123 | 2020-09-10 |
| 1831703537 | Shannon Leigh Doolittle | Audiologist | 3020 Children's Way Mc5010, San Diego, CA 92123 | 2020-09-01 |
| 1861014359 | Ha Thanh Truong | Pharmacist | Rezcare, 3821 Calle Fortunada, San Diego, CA 92123 | 2020-05-07 |
| 1023667136 | Brittany Meyer | Physical Therapist | 3020 Children's Waymc5068, San Diego, CA 92123 | 2019-09-11 |
| 1598313272 | Ryan Edward Shaw | Marriage & Family Therapist | 8910 Clairmont Mesa Blvd, San Diego, CA 92123 | 2019-08-27 |
| 1528611910 | Tanisha C Fulcher | Marriage & Family Therapist | 8825 Aero Dr., Ste 315, San Diago, CA 92123 | 2019-07-24 |
| 1245795665 | Robin James Pekin | Marriage & Family Therapist | 4450 Kearny Villa Rd, #116, San Diego, CA 92123 | 2019-02-11 |
| 1174093728 | Karen Vences | Counselor | 8755 Aero Dr Suite 230, San Diego, CA 92123 | 2018-11-27 |
| 1255808465 | Natasha Herrera | Counselor | 2801 Meadow Lark Dr, San Diego, San Diego, CA 92123 | 2018-10-25 |
| 1407321987 | Maneka Elikewela | Behavior Technician | 3934 Murphy Canyon Rd, Ste B202, San Diego, CA 92123 | 2018-10-10 |
| Find all providers in zip 92123 | ||||
| Taxonomy Code | 207LP3000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| Specialization | Pediatric Anesthesiology |
| An anesthesiologist who has had additional skill and experience in and is primarily concerned with the anesthesia, sedation, and pain management needs of infants and children. A pediatric anesthesiologist generally provides services including the evaluation of complex medical problems in infants and children when surgery is necessary, planning and care for children before and after surgery, pain control, anesthesia and sedation for any procedures out of the operating room such as MRI, CT scan, and radiation therapy. |
| Notes: Source: American Academy of Pediatrics, www.aap.org [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649880147 | Pediatric Office Anesthesia Specialists | Anesthesiology | 12625 High Bluff Dr Ste 301, San Diego, CA 92130-2054 | 2020-08-09 |
| 1447516414 | Claire Sampankanpanich Soria | Anesthesiology | 200 W Arbor Dr, Mc 8770, San Diego, CA 92103-9000 | 2012-04-04 |
| 1538431382 | Matthew Scott Wilder | Anesthesiology | 3020 Childrens Way, San Diego, CA 92123-4223 | 2012-02-08 |
| 1063685477 | Susanna Janes Shaw | Anesthesiology | 200 W Arbor Dr, San Diego, CA 92103-9000 | 2008-04-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457752198 | Mvp Pediatric and Urgent Care A Professional Corporation | Anesthesiology | 18555 Ventura Blvd Ste B, Tarzana, CA 91356-4101 | 2014-09-12 |
| 1518207471 | Robert W Wong | Anesthesiology | 1121 New Ave, Alhambra, CA 91801-4915 | 2013-02-28 |
| 1609145549 | Joanna Treder Kawecki | Anesthesiology | 13053 Maxwell Dr, Tustin, CA 92782-0919 | 2011-12-21 |
| 1891940078 | Susan Firestone | Anesthesiology | 4650 W Sunset Blvd # 3, Los Angeles, CA 90027-6062 | 2008-12-01 |
| 1619918364 | Toni Denise Daniels | Anesthesiology | 1430 13th Avenue, Oakland, CA 94606-1912 | 2006-06-10 |
| 1225596422 | Certified Anesthesia Consultants, Inc. | Anesthesiology | 1351 E Spruce Ave Ste 110, Fresno, CA 93720-3342 | 2019-03-06 |
| 1285192617 | Alexander R Schmidt | Anesthesiology | 300 Pasteur Dr, 3rd Floor Mail Code 5640, Stanford, CA 94305 | 2019-03-05 |
| 1104394329 | Scott C. Wallace Md Inc | Anesthesiology | 1415 Ross Ave, El Centro, CA 92243-4306 | 2018-11-06 |
| 1962944074 | Dennis Chang Md Pediatric Anesthesia Apc | Anesthesiology | 215 W Janss Rd, Thousand Oaks, CA 91360-1847 | 2016-11-07 |
| 1225494446 | Phillip Richardson Md Inc | Anesthesiology | 681 S Parker St, Ste 150, Orange, CA 92868-4719 | 2016-01-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.