ROBERT T. PETRUZZO JR. (NPI# 1578615936) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578615936 |
| Entity Type | Individual |
| Full Name | ROBERT T. PETRUZZO JR. |
| Credential | DO |
| Practice Address |
4405 Vandever Ave San Diego CA 92120-3315 |
| Mailing Address |
1153 Pine Dr El Cajon CA 92020-7248 |
| Practice Telephone | 6195285000 |
| Mailing Telephone | 0000000000 |
| Mailing Fax Number | 0000000000 |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2008-04-28 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085B0100X |
Radiology Specialization: Body Imaging |
20A4255 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00AX42550 | 05 |
| Street Address |
4405 VANDEVER AVE |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92120-3315 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679553101 | Jennifer Lin Khoe | Surgery | 4405 Vandever Ave, San Diego, CA 92120-3315 | 2006-01-19 |
| 1174162515 | Yana Kalendareva | Pharmacist | 4405 Vandever Ave, San Diego, CA 92120-3315 | 2020-01-02 |
| 1063977262 | Tiffany Cheng | Pharmacist | 4405 Vandever Ave, San Diego, CA 92120-3315 | 2019-02-01 |
| 1982182226 | Cheryl Z Bergman | Respiratory Therapist, Registered | 4405 Vandever Ave, San Diego, CA 92120-3315 | 2018-07-30 |
| 1518445832 | Marina Lenkov | Respiratory Therapist, Registered | 4405 Vandever Ave, San Diego, CA 92120-3315 | 2018-07-30 |
| 1841739646 | Denise Le | Pharmacist | 4405 Vandever Ave, 1st Floor Pharmacy, San Diego, CA 92120-3315 | 2017-02-14 |
| 1679011670 | Quynhhuong Dao | Pharmacist | 4405 Vandever Ave, 1st Floor Pharmacy, San Diego, CA 92120-3315 | 2017-02-09 |
| 1790223212 | Kaiser | Special Hospital | 4405 Vandever Ave, San Diego, CA 92120-3315 | 2017-02-03 |
| 1750768214 | Michelle Malilim | Pharmacist | 4405 Vandever Ave, San Diego, CA 92120-3315 | 2015-05-04 |
| 1710396585 | Phuong Thao Do | Pharmacist | 4405 Vandever Ave, San Diego, CA 92120-3315 | 2014-08-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316550510 | Jessica Elizabeth Knight | Student in an Organized Health Care Education/Training Program | 6383 Alvarado Ct, 310, San Diego, CA 92120 | 2020-08-26 |
| 1770195091 | Julia Roccanova | Student in an Organized Health Care Education/Training Program | 6383 Alvarado Court, Suite 310, San Diego, CA 92120 | 2020-08-18 |
| 1225593601 | Truself Training, Inc | Clinic/Center | 5125 Waring Road, San Diego, CA 92120 | 2019-02-09 |
| 1508381799 | Antin Sachs | In Home Supportive Care | 4420 Rainier Avenue, Suite 202, San Diego, CA 92120 | 2017-08-08 |
| 1588186415 | Matthew B Wilbat | Behavioral Analyst | 6851 Alvarado Rd., #17, San Diego, CA 92120 | 2017-07-12 |
| 1548782923 | Mori Khatibzadeh Dds Inc. | Clinic/Center | 6171 Mission Gorge Road, Suite #114, San Diego, CA 92120 | 2017-07-07 |
| 1306379359 | Ken Samith Oerding | Nurse Practitioner | 5422 Reservoir Drive, E7, San Diego Ca, CA 92120 | 2017-04-06 |
| 1396134409 | Debra Michele Stern-ellis | Social Worker | 4647 Zion Avenue Kaiser Permanente, 2nd Floor - Oncology, San Diego, CA 92120 | 2015-01-13 |
| 1821494717 | Shohreh Tourian | Dentist | 7451 Mission Gorge Road, San Diego, CA 92120 | 2014-11-05 |
| 1184049215 | Charles Yin | Counselor | 6153 Fairmount Ave Suite #260, San Diego, CA 92120 | 2014-02-26 |
| Find all providers in zip 92120 | ||||
| Taxonomy Code | 2085B0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Body Imaging |
| A Radiology doctor of Osteopathy that specializes in Body Imaging. |
| Notes: Source: National Uniform Claim Committee, 2008 [7/1/2008: definiton added, source added] Additional Resources: The American Osteopathic Board of Radiology no longer offers a certificate in this specialty. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518279710 | Alan Tsuyoshi Kuramoto | Radiology | 200 W Arbor Dr # 8756, San Diego, CA 92103-1911 | 2010-07-06 |
| 1134268006 | James Daniel Wolff Jr. | Radiology | 200 W. Arbor Dr, Mpf - L044, San Diego, CA 92103-8755 | 2007-02-06 |
| 1689647331 | James W Lyon | Radiology | 8745 Aero Dr, Suite 200, San Diego, CA 92123-1761 | 2006-02-10 |
| 1659341071 | Patrick H Carey | Radiology | 8745 Aero Drive, Suite 200, San Diego, CA 92123-1774 | 2006-01-26 |
| 1295158236 | Vu Luong | Radiology | 200 W Arbor Dr, Mail Code, San Diego, CA 92103-9000 | 2014-01-28 |
| 1427496710 | Aman Khurana | Radiology | 200 W Arbor Dr, Mc 8400, San Diego, CA 92103-9000 | 2013-06-07 |
| 1952747925 | Natalie Chen | Radiology | 200 W Arbor Dr, San Diego, CA 92103 | 2013-05-17 |
| 1164724449 | Masoud Shiehmorteza | Radiology | 200 W Arbor Dr, San Diego, CA 92103-9000 | 2010-11-18 |
| 1376854281 | Leonard Ong | Radiology | 200 W Arbor Dr, San Diego, CA 92103-9000 | 2010-06-24 |
| 1710149869 | Dwight Kenneth Lee | Radiology | 200 W Arbor Dr, University of California, San Diego, San Diego, CA 92103-9000 | 2008-06-30 |
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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.