Provider Demographics
NPI:1376567495
Name:PETIT, STEVEN J (MD AMC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:J
Last Name:PETIT
Suffix:
Gender:M
Credentials:MD AMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 S RAYMOND AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3278
Mailing Address - Country:US
Mailing Address - Phone:626-449-9920
Mailing Address - Fax:626-578-7366
Practice Address - Street 1:630 S RAYMOND AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3278
Practice Address - Country:US
Practice Address - Phone:626-449-9920
Practice Address - Fax:626-578-7366
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29872207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA756101173OtherRAILROAD MEDICARE PTAN
CA00G298720Medicaid
CA00G298720Medicaid
CA756101173OtherRAILROAD MEDICARE PTAN