Andrey Petrikovets MD a Professional Corporation
Organization Active NPI Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician · Los Angeles, CA
NPI 1013497213 · NPPES record last updated Dec 4, 2023
Key facts
- NPI
- 1013497213
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X
- License
- A127810 (CA)
- Legal business name
- ANDREY PETRIKOVETS MD A PROFESSIONAL CORPORATION
- Practice address
- 3312 Glendale Blvd
Los Angeles, CA 90039-1813 - Phone
- (888) 487-6496
- Fax
- (323) 250-1361
- NPI assigned
- Aug 16, 2018
- Organization subpart
- No
Authorized official
- Name
- Andrey Petrikovets, MD
- Title
- Owner
- Phone
- (888) 487-6496
Practitioners 1
-
Andrey Petrikovets, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20181010002449 | CA | Part B Supplier - Clinic/Group Practice | 9234481789 |
Receives reassigned benefits from 1 practitioner Practice locations: Los Angeles, CA; Glendale, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician |
207VF0040X | A127810 | CA | Yes |
Addresses
Primary practice location
3312 Glendale Blvd
Los Angeles, CA 90039-1813
Mailing address
PO Box 39466
Los Angeles, CA 90039-0466
Phone (888) 487-6496
Other practice location 1
1513 S Grand Ave Ste 400
Los Angeles, CA 90015-3075
Phone (213) 742-6400
Other providers in Los Angeles, CA
- Madison Lee Andrews
- Martha L. Andrews
- Natasha Nasha Andrews
- Sudria Elania Andrews
- Tracie J Andrews
- Monica Andriacchi
- Leah Andriasian
- Mary Angelina Andrighetto
- Kimberly Andrino-Gonzalez
- Kurt Androsky
All providers in Los Angeles, CA · Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.