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NPI Code Detail

MEDICARE: DR. LINDA DIANNE PETTEWAY PHD.

MEDICARE: DR. LINDA DIANNE PETTEWAY PHD.
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
2106H00000XMarriage & Family Therapist49813CA
3106H00000XMarriage & Family TherapistMFC 49813CA

General Provider Information

NPI Number : 1336277508
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LINDA DIANNE PETTEWAY PHD.
Provider Business Mailing Address
First Line : 4590 ALLSTATE DR
Second Line :
City : RIVERSIDE
State : CA
Zip : 92501-1702
Country : US
Telephone Number : 213-369-0162
Fax Number :
Provider Business Practice Location Address
First Line : 4590 ALLSTATE DR
Second Line :
City : RIVERSIDE
State : CA
Zip : 92501-1702
Country : US
Telephone Number : 213-369-0162
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 06/27/2023

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Directions to “ DR. LINDA DIANNE PETTEWAY PHD.” Practice Location

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