1336448299 NPI number — JAMES PETROS, M.D., INC.

Table of content: (NPI 1336448299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336448299 NPI number — JAMES PETROS, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES PETROS, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALLIED PAIN & SPINE INSTITUTE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336448299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1604 BLOSSOM HILL RD STE 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95124-6350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-528-8833
Provider Business Mailing Address Fax Number:
408-528-8557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14777 LOS GATOS BLVD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS GATOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95032-2059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-528-8833
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PETROS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
408-528-8833

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 305S00000X , with the licence number: A90732 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1588322960 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1043830896 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1598230617 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1326665886 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1568616563 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1184840522 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1194994996 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1831715531 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1174866107 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1043830896 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1205033594 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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