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General NPI Number Information
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NPI Number | 1740572965
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Entity Type | Individual
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Provider Name | BRIDGETTE J PETEET PHD
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Gender | Female
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Dates
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Enumeration Date | 05/05/2011
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Last Update Date | 05/06/2020
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Provider Practice Location Address
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Address Line | 11130 ANDERSON ST
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City | LOMA LINDA
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State | CA
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Zip | 92350-1729
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Country | US
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Telephone | 909-558-8717
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Fax |
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Provider Business Mailing Address
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Address Line | 11130 ANDERSON ST
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City | LOMA LINDA
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State | CA
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Zip | 92350-1729
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Country | US
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Telephone | 909-558-8717
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 31726
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6300
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License Number State | OH
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