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General NPI Number Information
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NPI Number | 1710177324
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Entity Type | Organization
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Legal Business Name | JOHN PETRAGLIA M.D., INC
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 14120 ALONDRA BLVD SUITE C
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City | SANTA FE SPRINGS
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State | CA
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Zip | 90670-5820
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Country | US
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Telephone | 562-407-2080
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4259
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City | CERRITOS
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State | CA
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Zip | 90703-4259
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Country | US
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Telephone | 562-407-2080
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN F PETRAGLIA
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Credential | M.D.
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Telephone | 562-407-2080
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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 | G68169
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License Number State | CA
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