Individual
PETRA AGU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1959 CHESTNUT AVE APT 305, LONG BEACH, CA 90806-6611
(562) 443-2255
Mailing address
1959 CHESTNUT AVE APT 305, LONG BEACH, CA 90806-6611
(562) 443-2255
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
A6807770
CA
Other
Enumeration date
03/02/2017
Last updated
03/02/2017
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