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General NPI Number Information
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NPI Number | 1770778490
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Entity Type | Organization
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Legal Business Name | EARL PETRUS MD INC
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 07/23/2010
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Provider Practice Location Address
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Address Line | 21000 PLUMMER ST
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City | CHATSWORTH
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State | CA
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Zip | 91311-4903
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Country | US
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Telephone | 818-882-6400
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Fax | 818-882-6404
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Provider Business Mailing Address
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Address Line | PO BOX 64487
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City | LOS ANGELES
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State | CA
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Zip | 90064-0487
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Country | US
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Telephone | 310-820-7197
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Fax | 310-478-1876
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EARL PETRUS
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Credential | M.D.
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Telephone | 310-820-7197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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