Provider Demographics
NPI:1417956004
Name:MOTIU, PETRE P (MD)
Entity Type:Individual
Prefix:DR
First Name:PETRE
Middle Name:P
Last Name:MOTIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249-0369
Mailing Address - Country:US
Mailing Address - Phone:209-772-1190
Mailing Address - Fax:209-920-3158
Practice Address - Street 1:52 LAUREL ST
Practice Address - Street 2:
Practice Address - City:VALLEY SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95252
Practice Address - Country:US
Practice Address - Phone:209-772-1190
Practice Address - Fax:209-920-3158
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70236207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G75603Medicare UPIN
CA00A702361Medicare ID - Type Unspecified