Mirena Petrous, RN

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

95159089 Issued in CA

Practice address

2001 The Alameda
San Jose, CA 95126-1136

Phone

(408) 261-7777

Fax

(408) 259-2273

NPI assigned

Jul 9, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Irena Petrous Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562630400000",
    "number": "1043862105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 SUZANNE DR",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943064336",
            "telephone_number": "917-494-7477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 THE ALAMEDA",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951261136",
            "telephone_number": "408-261-7777",
            "fax_number": "408-259-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROUS",
        "first_name": "MIRENA",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-09",
        "last_updated": "2019-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95159089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IRENA",
            "last_name": "PETROUS",
            "credential": "RN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Diane Carole Petroni, PHD MFT
• George Petros, D.C.
• James Petros, M.D.
• Ramiz R Petros, D.M.D
• Tigran Petrosyan
• Craig Alan Pettengill, D.D.S.
• Katrina Larea Pettersen, LEP 4489
• Timothy William Pettett, SUDRC #16547
• Kyle Pettit, M.A.
• Mahleiah Amele Pettus-Johnson

• Psychiatric/Mental Health Registered Nurse in San Jose, CA
• Providers in San Jose, CA by specialty
• Psychiatric/Mental Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.