MEDICARE: JOHN FRANCIS PETRAGLIA M.D.

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
1	207L00000X	Anesthesiology Physician	G68169	CA
2	208VP0014X	Interventional Pain Medicine Physician	G68169	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417933938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN FRANCIS PETRAGLIA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3969
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-3969
Country	:	US
Telephone Number	:	562-407-2080
Fax Number	:	562-407-2082

Provider Business Practice Location Address
First Line	:	1601 DOVE ST
Second Line	:	SUITE 170
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2433
Country	:	US
Telephone Number	:	949-474-7246
Fax Number	:	949-474-7247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	04/12/2011

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