Healthcare Provider Details

I. General information

NPI: 1134423387
Provider Name (Legal Business Name): THOMAS SEAN WILLIAM PETIT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THOMAS SEAN WILLIAM PETIT MD

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date: 02/18/2026
Reactivation Date: 02/20/2026

III. Provider practice location address

10937 FIRESTONE BLVD
NORWALK CA
90650-2242
US

IV. Provider business mailing address

10937 FIRESTONE BLVD
NORWALK CA
90650-2242
US

V. Phone/Fax

Practice location:
  • Phone: 562-262-2111
  • Fax:
Mailing address:
  • Phone: 562-262-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME144317
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC196078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: