Provider Demographics
NPI:1740076355
Name:PETROVICH, IRINA
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:PETROVICH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8924 CAPCANO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1415
Mailing Address - Country:US
Mailing Address - Phone:619-886-5598
Mailing Address - Fax:
Practice Address - Street 1:8924 CAPCANO RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-1415
Practice Address - Country:US
Practice Address - Phone:619-886-5598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter