Active NPI
Brent Eric Petty, RVT, RDMS
- Vascular Sonography Radiologic Technologist
- Inglewood, CA
National Provider Identifier
1992449680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Sonography Radiologic Technologist
- License
- 146300
- Practice address
- 530 E Queen St
Inglewood, CA 90301-1929 - Phone
- (310) 946-3707
- NPI assigned
- Apr 27, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Sonography Radiologic Technologist | 2471V0105X | 146300 | TX | Primary |
Addresses
Primary practice location
530 E Queen St
Inglewood, CA 90301-1929
Mailing address
530 E Queen St
Inglewood, CA 90301-1929
Phone (310) 946-3707
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146300 | TX | MD | Vascular Sonography Radiologic Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651017600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651017600000",
"number": "1992449680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "530 E QUEEN ST",
"city": "INGLEWOOD",
"state": "CA",
"postal_code": "903011929",
"telephone_number": "310-946-3707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 E QUEEN ST",
"city": "INGLEWOOD",
"state": "CA",
"postal_code": "903011929",
"telephone_number": "310-946-3707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTY",
"first_name": "BRENT",
"middle_name": "ERIC",
"credential": "RVT, RDMS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-04-27",
"last_updated": "2022-04-27",
"certification_date": "2022-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "2471V0105X",
"taxonomy_group": "",
"desc": "Radiologic Technologist, Vascular Sonography",
"state": "TX",
"license": "146300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Inglewood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.