Provider Demographics
NPI:1255342929
Name:PETRASCU, ANCA MARIA (MD)
Entity type:Individual
Prefix:
First Name:ANCA
Middle Name:MARIA
Last Name:PETRASCU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 S DEMAREE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9476
Mailing Address - Country:US
Mailing Address - Phone:559-625-4011
Mailing Address - Fax:559-625-4019
Practice Address - Street 1:4050 S DEMAREE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9476
Practice Address - Country:US
Practice Address - Phone:559-625-4011
Practice Address - Fax:559-625-4019
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66037207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A660370Medicaid
CA00A660370Medicaid
00A660370Medicare PIN