Healthcare Provider Details

I. General information

NPI: 1437412483
Provider Name (Legal Business Name): PETRA VETTER CMT,CPMT,CD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2012
Last Update Date: 06/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16941 BELLOTA DR
SAN DIEGO CA
92128-2608
US

IV. Provider business mailing address

16941 BELLOTA DR
SAN DIEGO CA
92128-2608
US

V. Phone/Fax

Practice location:
  • Phone: 858-774-5480
  • Fax:
Mailing address:
  • Phone: 858-774-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number171
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: