Active NPI
Justine Anne Petrie, MD
- Psychiatry Physician
- Fullerton, CA
National Provider Identifier
1730264912
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- C38832
- Practice address
- 2228 N State College Blvd
Fullerton, CA 92831-1361 - Phone
- (714) 990-0700
- Fax
- (714) 990-0142
- NPI assigned
- Oct 26, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | C38832 | CA | Primary |
| Sleep Medicine (Psychiatry & Neurology) Physician | 2084S0012X | C38832 | CA |
Addresses
Primary practice location
2228 N State College Blvd
Fullerton, CA 92831-1361
Mailing address
2228 N State College Blvd
Fullerton, CA 92831-1361
Phone (714) 990-0700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C38832 | CA | MD | Sleep Medicine (Psychiatry & Neurology) Physician |
| 38832 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207612800000",
"number": "1730264912",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2228 N STATE COLLEGE BLVD",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928311361",
"telephone_number": "714-990-0700",
"fax_number": "714-990-0142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2228 N STATE COLLEGE BLVD",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928311361",
"telephone_number": "714-990-0700",
"fax_number": "714-990-0142"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRIE",
"first_name": "JUSTINE",
"middle_name": "ANNE",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-26",
"last_updated": "2008-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "C38832",
"primary": true
},
{
"code": "2084S0012X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Sleep Medicine",
"state": "CA",
"license": "C38832",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.