Provider Demographics
NPI:1396219622
Name:POSCHMANN, PETRA C
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:C
Last Name:POSCHMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 MILTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-2820
Mailing Address - Country:US
Mailing Address - Phone:626-644-7945
Mailing Address - Fax:
Practice Address - Street 1:825 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3424
Practice Address - Country:US
Practice Address - Phone:626-471-9710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator