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NPI Code Detail

MEDICARE: PETRA KRUPP PA-C

MEDICARE: PETRA KRUPP PA-C
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
1363AM0700XMedical Physician AssistantPA16175CA

General Provider Information

NPI Number : 1609938117
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETRA KRUPP PA-C
Provider Business Mailing Address
First Line : 10470 OLD PLACERVILLE RD
Second Line : SUITE 100
City : SACRAMENTO
State : CA
Zip : 95827-2539
Country : US
Telephone Number : 800-470-0071
Fax Number :
Provider Business Practice Location Address
First Line : 10470 OLD PLACERVILLE RD
Second Line : SUITE 100
City : SACRAMENTO
State : CA
Zip : 95827-2539
Country : US
Telephone Number : 916-817-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2006
Last Update Date : 07/27/2015

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1467508382 — JOHANN MILIAN PETERSON M.D.
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Directions to “ PETRA KRUPP PA-C” Practice Location

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