BRODI THOMAS PETITT (NPI# 1417439910) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417439910 |
| Entity Type | Individual |
| Full Name | BRODI THOMAS PETITT |
| Practice Address |
3125 Myers St Riverside CA 92503-5527 |
| Practice Telephone | 9519557829 |
| Mailing Telephone | 9519557829 |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2018-08-30 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Street Address |
3125 MYERS ST |
| City | RIVERSIDE |
| State | CA |
| Zip Code | 92503-5527 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407968068 | Richard Joonkoo Lee | Psychiatry & Neurology | 3125 Myers St, Rcdmh Children's Treatment Services, Riverside, CA 92503-5527 | 2006-08-31 |
| 1821616616 | Mayra Mariscal | Case Manager/Care Coordinator | 3125 Myers St, Riverside, CA 92503-5527 | 2020-07-08 |
| 1003434986 | Marco Antonio Elias-juarez | Marriage & Family Therapist | 3125 Myers St, Riverside, CA 92503-5527 | 2020-07-08 |
| 1831723980 | Kimberly N/a Franco | Marriage & Family Therapist | 3125 Myers St, Riverside, CA 92503-5527 | 2020-02-27 |
| 1609419860 | Melissa Aimee Benson | Marriage & Family Therapist | 3125 Myers St, Riverside, CA 92503-5527 | 2019-10-21 |
| 1023678810 | Aaron A Alonso | Case Manager/Care Coordinator | 3125 Myers St, Riverside, CA 92503-5527 | 2019-06-14 |
| 1730746371 | Cassandra Rodriquez | Counselor | 3125 Myers St, Riverside, CA 92503 | 2019-05-20 |
| 1548745763 | Eddy Anne Garcia | Peer Specialist | 3125 Myers St, Riverside, CA 92503-5527 | 2018-10-03 |
| 1053891101 | Adriyel Angel Carrillo | Counselor | 3125 Myers St, Riverside, CA 92503-5527 | 2018-08-17 |
| 1942789508 | Ana Bertha Ramirez-gutierrez | Counselor | 3125 Myers St, Riverside, CA 92503 | 2018-08-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255953618 | Mohammad Abul-fielat Dds Inc | Dentist | 3825 Tyler St, Riverside, CA 92503 | 2020-05-08 |
| 1205396488 | Francisco Aguayo | Behavioral Analyst | 3345 Jackson St, Riverside, CA 92503 | 2019-03-22 |
| 1073071684 | Racheal Ego Aneke | Nurse Practitioner | 9890 County Farm Rd., Building 2, Riverside, CA 92503 | 2019-03-04 |
| 1073070264 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 3500 Tyler Mall, Riverside, CA 92503 | 2019-02-25 |
| 1053893271 | Tsibel Dental Practice Inc. | Dentist | 10181 Magnolia Ave, Riverside, CA 92503 | 2018-09-04 |
| 1508344714 | Patricia Marraine Redondo | Counselor | 1625 14th St, Riverside, CA 92503 | 2018-07-31 |
| 1740766146 | Robles Rodef & Yaghoubi Dental Corporation | Dentist | 5628 Van Buren Blvd Suite #a, Riverside, CA 92503 | 2018-07-18 |
| 1467961755 | Daniela Popa | Assisted Living Facility | 10820 Calle Bella, Riverside, CA 92503 | 2017-09-29 |
| 1457860306 | Leah Dreany | Peer Specialist | 2085 Rustin Avenue Building #3, Riverside, CA 92503 | 2017-09-22 |
| 1710400445 | Christopher John Guting | Peer Specialist | 10230 Indiana Avenue, Riverside, CA 92503 | 2017-07-25 |
| Find all providers in zip 92503 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477047835 | Deborah Kay Allen | Peer Specialist | 6939 Morningside Ave, Riverside, CA 92504 | 2018-06-19 |
| 1053802769 | Miesha Hale | Peer Specialist | 1820 University Ave Ste 2b, Riverside, CA 92507-5355 | 2018-05-29 |
| 1538677612 | Monica Munoz | Peer Specialist | 9991c County Farm Rd, Riverside, CA 92503-3506 | 2018-01-11 |
| 1457860306 | Leah Dreany | Peer Specialist | 2085 Rustin Avenue Building #3, Riverside, CA 92503 | 2017-09-22 |
| 1043738099 | Colene Lavonne Roberts | Peer Specialist | 9890 County Farm Rd # 2, Riverside, CA 92503-3505 | 2017-08-30 |
| 1710400445 | Christopher John Guting | Peer Specialist | 10230 Indiana Avenue, Riverside, CA 92503 | 2017-07-25 |
| 1841713203 | Denise Darlene Leeper | Peer Specialist | 771 W. Blaine St, Suite C., Riverside, CA 92507 | 2017-07-18 |
| 1427590058 | Jennifer Hayford | Peer Specialist | 3250 Panorama Rd Apt 139, Riverside, CA 92506-1351 | 2016-11-14 |
| 1144693953 | Michelle Elaine Martinez | Peer Specialist | 5012 Arlington Ave, Riverside, CA 92504-2710 | 2015-11-03 |
| 1558733824 | Gina Irvin | Peer Specialist | 771 W Blaine St # C, Riverside, CA 92507-3940 | 2015-10-27 |
| Find all providers in RIVERSIDE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.