Provider Demographics
NPI:1992734420
Name:PETERSEN, DIANE YVONNE (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:YVONNE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3565 DEL AMO BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1637
Mailing Address - Country:US
Mailing Address - Phone:310-214-0811
Mailing Address - Fax:310-793-0754
Practice Address - Street 1:3565 DEL AMO BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1637
Practice Address - Country:US
Practice Address - Phone:310-214-0811
Practice Address - Fax:310-793-0754
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-11-05
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Provider Licenses
StateLicense IDTaxonomies
CAG54758207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology