Organization
PAVEL V PETRIK MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAVEL V PETRIK MD (CEO)
(661) 522-3256
Entity
Organization
Contact information
Practice address
44725 10TH ST W STE 120, LANCASTER, CA 93534-3051
(661) 522-3256
(661) 940-0206
Mailing address
PO BOX 8700, LANCASTER, CA 93539-8700
(661) 522-3256
(661) 940-0206
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
A74861
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
74861
CA MEDICAL LICENSE
CA
Enumeration date
08/31/2018
Last updated
12/09/2021
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