Individual
TOMMY PETCH EAGATATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
301 VICTORIA ST, COSTA MESA, CA 92627-7131
(949) 574-3365
Mailing address
301 VICTORIA ST, COSTA MESA, CA 92627-1995
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95231640
CA
Other
Enumeration date
04/09/2024
Last updated
04/09/2024
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