Healthcare Provider Details

I. General information

NPI: 1457268815
Provider Name (Legal Business Name): JAMES PETROS, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39650 LIBERTY ST STE 430
FREMONT CA
94538-2261
US

IV. Provider business mailing address

1604 BLOSSOM HILL RD STE 10
SAN JOSE CA
95124-6350
US

V. Phone/Fax

Practice location:
  • Phone: 408-528-8833
  • Fax: 408-827-4171
Mailing address:
  • Phone: 408-528-8833
  • Fax: 408-827-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE WATERSTREET
Title or Position: PRACTICE MANAGER
Credential:
Phone: 408-528-8833