Provider Demographics
NPI:1922307123
Name:PETRIKOVETS, ANDREY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREY
Middle Name:
Last Name:PETRIKOVETS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDRE
Other - Middle Name:
Other - Last Name:PETRIKOVETS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD FACOG
Mailing Address - Street 1:PO BOX 39466
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-0466
Mailing Address - Country:US
Mailing Address - Phone:888-487-6496
Mailing Address - Fax:323-250-1361
Practice Address - Street 1:3312 GLENDALE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1813
Practice Address - Country:US
Practice Address - Phone:888-487-6496
Practice Address - Fax:323-250-1361
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA127810207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program