Provider Demographics
NPI:1013497213
Name:ANDREY PETRIKOVETS MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ANDREY PETRIKOVETS MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRIKOVETS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-487-6496
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA127810207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty