Individual provider Active NPI

Christine A Petti, MD

  • Plastic Surgery Physician
  • Torrance, CA
National Provider Identifier
1568634285
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
G58432 Issued in CA
Practice address
23365 Hawthorne Blvd Ste 102
Torrance, CA 90505-3736
Phone
(310) 539-5888
Fax
(310) 375-0789
NPI assigned
Apr 2, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X G58432 CA Primary

Addresses

Primary practice location

23365 Hawthorne Blvd Ste 102
Torrance, CA 90505-3736

Mailing address

30911 Rue Langlois
Rancho Palos Verdes, CA 90275-5330
Phone (310) 539-5888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090519000392 CA Practitioner - Plastic and Reconstructive Surgery 7618969544 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Medical College of Pennsylvania, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

23365 Hawthorne Blvd
Suite 102
Torrance, CA 90505-3736
Phone (310) 539-5888

Hospital & facility affiliations

  • Torrance Memorial Medical Center Hospital, Torrance, CA, CCN 050351

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Csi Medical Group CurrentSince Apr 15, 2020 Accepting new patients
Susan Goodlerner MD Inc CurrentSince Jun 1, 2020 Accepting new patients
Palos Verdes Ambulatory Surgery Center, Inc. CurrentSince Jun 4, 2003 Accepting new patients

Locations

6399 San Ignacio Ave
Ste 120
San Jose, CA 95119
Phone (408) 369-5620

4201 Torrance Blvd
Ste 640
Torrance, CA 90503
Phone (310) 375-9994

23451 Madison St
Ste 330
Torrance, CA 90505
Phone (310) 375-9994

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1568634285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30911 RUE LANGLOIS",
            "city": "RANCHO PALOS VERDES",
            "state": "CA",
            "postal_code": "902755330",
            "telephone_number": "310-539-5888",
            "fax_number": "310-517-9916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23365 HAWTHORNE BLVD STE 102",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905053736",
            "telephone_number": "310-539-5888",
            "fax_number": "310-375-0789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTI",
        "first_name": "CHRISTINE",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-02",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "G58432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Torrance, CA

Sources for this page

Verify at the official NPI Registry.