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General NPI Number Information
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NPI Number | 1912062647
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Entity Type | Organization
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Legal Business Name | PETRECCIA AND TROTTER MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 1275 N. ROSE DRIVE SUITE 134
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City | PLACENTIA
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State | CA
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Zip | 92870-3919
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Country | US
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Telephone | 714-996-6500
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Fax | 714-996-1722
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Provider Business Mailing Address
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Address Line | 1275 N. ROSE DRIVE SUITE 134
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City | PLACENTIA
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State | CA
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Zip | 92870-3919
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Country | US
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Telephone | 714-996-6500
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Fax | 714-996-1722
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOEL A. TROTTER
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Credential | M.D.
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Telephone | 714-996-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | G65207
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License Number State | CA
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