Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 146389 | CA |
Y | 111NI0900X | Internist | 146389 | CA |
N | 207R00000X | Internist | P8292 | TX |
N | 111NI0900X | Internist | P8292 | TX |
NPI | 1003128679 |
---|---|
Provider Name | Petru Papacostea |
First Address | Loma Linda, CA 92357-1000 |
Second Address | Loma Linda, CA 92357-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2010 |
Last Update Date | 23/02/2017 |