Provider Demographics
NPI:1699719369
Name:PETRUNCIO, CLAUDIA M (DO)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:M
Last Name:PETRUNCIO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MARCELA DR
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-5769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 MARCELA DR
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-5769
Practice Address - Country:US
Practice Address - Phone:707-459-6115
Practice Address - Fax:856-429-3794
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005158207R00000X
NJ25MB04695500207R00000X
CA15732207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ201290120Medicaid
DO44603OtherCDS
DO44603OtherCDS
455796Medicare ID - Type Unspecified
NJ201290120Medicaid