Provider Demographics
NPI:1962549279
Name:PEACE, SHERRI (MD)
Entity type:Individual
Prefix:DR
First Name:SHERRI
Middle Name:
Last Name:PEACE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHERRI
Other - Middle Name:
Other - Last Name:PRICE-PEACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8930 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3606
Mailing Address - Country:US
Mailing Address - Phone:310-645-6001
Mailing Address - Fax:310-645-5919
Practice Address - Street 1:8930 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3606
Practice Address - Country:US
Practice Address - Phone:310-645-6001
Practice Address - Fax:310-645-5919
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72196207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G721960Medicaid
CAG72196OtherBLUE CROSS PROVIDER #
CA05D0966774OtherCLIA #
CA00G721960OtherBLUE SHIELD PROVIDER #
CA00G721960OtherBLUE SHIELD PROVIDER #
CAWG72196DMedicare ID - Type UnspecifiedPROVIDER NUMBER