Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A55360 | CA |
NPI | 1003804089 |
---|---|
Provider Name | Catherine Petronijevic |
First Address | Salinas, CA 93907-8541 |
Second Address | Salinas, CA 93907-8541 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 27/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E73352 | (02) |