Provider Demographics
NPI:1922210251
Name:PETERSEN, ERIK J (MD)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:J
Last Name:PETERSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3151 AIRWAY AVE STE G1
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4624
Mailing Address - Country:US
Mailing Address - Phone:714-545-5550
Mailing Address - Fax:714-708-2588
Practice Address - Street 1:19671 BEACH BLVD STE 215
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5903
Practice Address - Country:US
Practice Address - Phone:714-545-5550
Practice Address - Fax:949-609-0374
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012527082084P0800X, 2084P0802X, 2084P0805X, 2084P0800X
CAA1375892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry