Provider Demographics
NPI:1710620554
Name:JAMES PETROS, M.D., INC.
Entity Type:Organization
Organization Name:JAMES PETROS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERSTREET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-528-8833
Mailing Address - Street 1:1604 BLOSSOM HILL RD STE 10
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-6350
Mailing Address - Country:US
Mailing Address - Phone:408-528-8833
Mailing Address - Fax:
Practice Address - Street 1:433 ESTUDILLO AVE STE 305
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4915
Practice Address - Country:US
Practice Address - Phone:408-528-8833
Practice Address - Fax:408-827-4171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES PETROS, MD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty