Provider Demographics
NPI:1538259080
Name:CHRISTINE PETTI MD, INC.
Entity type:Organization
Organization Name:CHRISTINE PETTI MD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-517-8689
Mailing Address - Street 1:30911 RUE LANGLOIS
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-5330
Mailing Address - Country:US
Mailing Address - Phone:310-750-7363
Mailing Address - Fax:424-237-2336
Practice Address - Street 1:23365 HAWTHORNE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3736
Practice Address - Country:US
Practice Address - Phone:310-539-5888
Practice Address - Fax:310-517-9916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE36027Medicare UPIN
CAW13327Medicare PIN
CAWG58432BMedicare PIN