1841700549 NPI number — JOAN PETRILLI FERRARI OTR/L, CHT

Table of content: JOAN PETRILLI FERRARI OTR/L, CHT (NPI 1841700549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841700549 NPI number — JOAN PETRILLI FERRARI OTR/L, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRARI
Provider First Name:
JOAN
Provider Middle Name:
PETRILLI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETRILLI
Provider Other First Name:
JOAN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841700549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2328 WESTMORELAND DR
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:
95124-1146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-930-9779
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39180 FARWELL DR STE 211
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94538-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-857-1000
Provider Business Practice Location Address Fax Number:
510-857-1001
Provider Enumeration Date:
10/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  7406 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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