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NPI Code Detail

MEDICARE: DAVID PETRIE MA

MEDICARE: DAVID PETRIE MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1326179581
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID PETRIE MA
Provider Business Mailing Address
First Line : 5032 HUB ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90042-2315
Country : US
Telephone Number : 323-644-2000
Fax Number :
Provider Business Practice Location Address
First Line : 1891 EFFIE ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-1793
Country : US
Telephone Number : 323-644-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 09/08/2010

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Directions to “ DAVID PETRIE MA” Practice Location

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