Provider Demographics
NPI:1427563485
Name:PETRICH, JOSEPHINE FINNERAN
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:FINNERAN
Last Name:PETRICH
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 1:6558 TAIT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-6528
Mailing Address - Country:US
Mailing Address - Phone:858-349-8157
Mailing Address - Fax:
Practice Address - Street 1:6558 TAIT ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-6528
Practice Address - Country:US
Practice Address - Phone:858-349-8157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA519OtherCALIFORNIA MEDICAL BOARD
17100003OtherNORTH AMERICAN REGISTRY OF MIDWIVES