MEDICARE: DR. PETRE P MOTIU 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	207V00000X	Obstetrics & Gynecology Physician	A70236	CA

General Provider Information

NPI Number	:	1417956004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETRE P MOTIU M.D.

Provider Business Mailing Address
First Line	:	PO BOX 369
Second Line	:
City	:	SAN ANDREAS
State	:	CA
Zip	:	95249-0369
Country	:	US
Telephone Number	:	209-772-1190
Fax Number	:	209-920-3158

Provider Business Practice Location Address
First Line	:	52 LAUREL ST
Second Line	:
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252
Country	:	US
Telephone Number	:	209-772-1190
Fax Number	:	209-920-3158

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	02/02/2012

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