Healthcare Provider Details

I. General information

NPI: 1902085277
Provider Name (Legal Business Name): STEVEN J PETIT MD A M C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S RAYMOND AVE SUITE 240
PASADENA CA
91105-3278
US

IV. Provider business mailing address

630 S RAYMOND AVE SUITE 240
PASADENA CA
91105-3278
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-9920
  • Fax: 626-578-7366
Mailing address:
  • Phone: 626-449-9920
  • Fax: 626-578-7366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG29872
License Number StateCA

VIII. Authorized Official

Name: MRS. ANN MARIE CASELLA
Title or Position: OFFICE MANAGER
Credential:
Phone: 626-449-9920