Healthcare Provider Details

I. General information

NPI: 1225265325
Provider Name (Legal Business Name): PETRA MICKY OBRADOVIC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 STOCKDALE HWY #105
BAKERSFIELD CA
93311-3632
US

IV. Provider business mailing address

9900 STOCKDALE HWY #105
BAKERSFIELD CA
93311-3632
US

V. Phone/Fax

Practice location:
  • Phone: 661-410-9500
  • Fax:
Mailing address:
  • Phone: 661-410-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA106488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: