Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | A127810 | CA |
NPI | 1922307123 |
---|---|
Provider Name | Dr. Andrey Petrikovets |
First Address | Los Angeles, CA 90035-9636 |
Second Address | Los Angeles, CA 90015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2011 |
Last Update Date | 10/08/2018 |