Provider Demographics
NPI:1568634285
Name:PETTI, CHRISTINE A (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:PETTI
Suffix:
Gender:F
Credentials:MD
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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:310-539-5888
Mailing Address - Fax:310-517-9916
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:310-375-0789
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2024-01-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG58432208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE36027Medicare UPIN
CAW13327Medicare PIN
CAWG58432BMedicare PIN