Provider Demographics
NPI:1922141621
Name:SARDELICH, PETAR (MFT/PT/MAC)
Entity Type:Individual
Prefix:
First Name:PETAR
Middle Name:
Last Name:SARDELICH
Suffix:
Gender:M
Credentials:MFT/PT/MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E COLORADO BLVD
Mailing Address - Street 2:SUITE 530
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1915
Mailing Address - Country:US
Mailing Address - Phone:626-676-0541
Mailing Address - Fax:
Practice Address - Street 1:301 E COLORADO BLVD
Practice Address - Street 2:SUITE 530
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1915
Practice Address - Country:US
Practice Address - Phone:626-676-0541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44180106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist