Healthcare Provider Details

I. General information

NPI: 1174045009
Provider Name (Legal Business Name): PETER A. STATTI MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S. MILLER ST. #12
SANTA MARIA CA
93454
US

IV. Provider business mailing address

1414 S MILLER ST STE 12
SANTA MARIA CA
93454-6916
US

V. Phone/Fax

Practice location:
  • Phone: 805-922-8311
  • Fax: 805-349-1251
Mailing address:
  • Phone: 805-922-8311
  • Fax: 805-349-1251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG13500
License Number StateCA

VIII. Authorized Official

Name: DR. PETER ANTHONY STATTI
Title or Position: PRESIDENT
Credential: MD
Phone: 805-922-8311