Individual
DR. MARIA M. PETRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
130 STONY POINT RD, SUITE E, SANTA ROSA, CA 95401-4120
(707) 525-0211
(707) 525-0491
Mailing address
130 STONY POINT RD, SUITE E, SANTA ROSA, CA 95401-4120
(707) 525-0211
(707) 525-0491
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
01063403A
IN
207K00000X
Allergy & Immunology Physician
40808
KY
207K00000X
Allergy & Immunology Physician
Primary
C132754
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000514027
ANTHEM PIN
KY
05
—
200855600
—
IN
01
—
50015240
PASSPORT
KY
05
—
7100013590
—
KY
05
—
GR0061440
—
CA
01
—
HKRAA3F00
HIN NUMBER
—
01
—
P00411953
RAILROAD MEDICARE
KY
01
—
ZZZ95243Z
MEDICARE PTAN
—
Enumeration date
07/11/2005
Last updated
11/16/2015
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