Provider Demographics
NPI:1932330867
Name:PETRISHEN, OREST V (ND, PHD, CNC)
Entity Type:Individual
Prefix:DR
First Name:OREST
Middle Name:V
Last Name:PETRISHEN
Suffix:
Gender:M
Credentials:ND, PHD, CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 WILSHIRE BLVD
Mailing Address - Street 2:STE #200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5702
Mailing Address - Country:US
Mailing Address - Phone:323-382-4211
Mailing Address - Fax:323-654-5373
Practice Address - Street 1:6333 WILSHIRE BLVD
Practice Address - Street 2:STE #200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5702
Practice Address - Country:US
Practice Address - Phone:323-653-2504
Practice Address - Fax:323-653-2515
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCNC-2372133N00000X
DCNAT-375175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No175F00000XOther Service ProvidersNaturopath