Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 35-096431 | OH |
NPI | 1144310756 |
---|---|
Provider Name | Peter Crist Kouretas |
First Address | San Francisco, CA 94143-2549 |
Second Address | San Francisco, CA 94143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 31/07/2018 |