MEDICARE: DR. JOHN C PETRICCIANI 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	208D00000X	General Practice Physician	GFE16109	CA

General Provider Information

NPI Number	:	1447496948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN C PETRICCIANI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1925
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92263-1925
Country	:	US
Telephone Number	:	760-416-2686
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 LADERA CIR
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4122
Country	:	US
Telephone Number	:	760-416-2686
Fax Number	:

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

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	01/05/2009

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