Provider Demographics
NPI:1417767401
Name:PETRIGLIANO, PAMELA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:PETRIGLIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1514
Mailing Address - Country:US
Mailing Address - Phone:714-225-5726
Mailing Address - Fax:
Practice Address - Street 1:8831 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3223
Practice Address - Country:US
Practice Address - Phone:310-204-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program