Provider Demographics
NPI:1669511291
Name:PIETRAFESA, CHARLES ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANDREW
Last Name:PIETRAFESA
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 1:12139 LA CASA LN
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-1548
Mailing Address - Country:US
Mailing Address - Phone:310-570-8090
Mailing Address - Fax:
Practice Address - Street 1:12139 LA CASA LN
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-1548
Practice Address - Country:US
Practice Address - Phone:310-570-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41797207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48695Medicare UPIN