Provider Demographics
NPI:1740369792
Name:PETTINELLI, ROMEO JOSEPH (DPM)
Entity type:Individual
Prefix:DR
First Name:ROMEO
Middle Name:JOSEPH
Last Name:PETTINELLI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12660 RIVERSIDE DR STE 305
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3431
Mailing Address - Country:US
Mailing Address - Phone:818-623-4455
Mailing Address - Fax:818-985-0055
Practice Address - Street 1:12660 RIVERSIDE DR STE 305
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91607-3431
Practice Address - Country:US
Practice Address - Phone:818-623-4455
Practice Address - Fax:818-985-0055
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2873213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWE2873DMedicare ID - Type UnspecifiedIRVINE
CAWE2873CMedicare ID - Type UnspecifiedSTUDIO CITY/ WESTWOOD
CAU86681Medicare UPIN
CAWE2873EMedicare ID - Type UnspecifiedAGOURA HILLS