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General NPI Number Information
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NPI Number | 1275675613
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Entity Type | Individual
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Provider Name | ERNESTINE R PETTY M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 1300 N VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027-6098
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Country | US
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Telephone | 213-413-3000
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Fax | 323-666-2939
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Provider Business Mailing Address
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Address Line | 210 N TUSTIN AVE
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City | SANTA ANA
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State | CA
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Zip | 92705-3807
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Country | US
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Telephone | 714-347-1000
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Fax | 714-647-1245
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G71691
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License Number State | CA
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