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Individual

STEPHEN J PETTIS II

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
ATC

Contact information

Practice address
12974 W VIA CAMILLE, EL MIRAGE, AZ 85335-5300
(619) 379-8814
Mailing address
12974 W VIA CAMILLE, EL MIRAGE, AZ 85335-5300
(619) 379-8814

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
ATR-009254
AZ
2255A2300X
Athletic Trainer
Primary
CA

Other

Enumeration date
11/06/2019
Last updated
05/25/2022
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