Healthcare Provider Details

I. General information

NPI: 1336448299
Provider Name (Legal Business Name): JAMES PETROS, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 05/11/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14777 LOS GATOS BLVD STE 201
LOS GATOS CA
95032-2059
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:
Mailing address:
  • Phone: 408-528-8833
  • Fax: 408-528-8557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberA90732
License Number StateCA

VIII. Authorized Official

Name: DR. JAMES PETROS
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 408-528-8833