Organization
ROBERT M PETTIS MD INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT M PETTIS MD (PRESIDENT)
(949) 715-0500
Entity
Organization
Contact information
Practice address
31862 COAST HWY STE 302, LAGUNA BEACH, CA 92651-6772
(949) 715-0500
Mailing address
PO BOX 7630, LAGUNA NIGUEL, CA 92607-7630
(949) 643-3345
(949) 643-3560
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
A77461
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A77461
STATE LICENSE
CA
Enumeration date
02/02/2007
Last updated
07/28/2010
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