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General NPI Number Information
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NPI Number | 1457326266
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Entity Type | Individual
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Provider Name | LIDIJA PETROVIC MD
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Gender | Female
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 1510 SAN PABLO ST FL 6
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City | LOS ANGELES
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State | CA
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Zip | 90033-5320
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Country | US
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Telephone | 323-442-4815
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31309
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City | LOS ANGELES
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State | CA
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Zip | 90031-0309
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Country | US
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Telephone | 323-442-2582
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Fax | 323-442-2588
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 226218
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | A52273
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License Number State | CA
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