TIMOTHY PETTETT, SUDRC #16547

Counselor

Active Individual
NPI: 1104545490

Practice Address

298 BERNAL RD
San Jose, CA 95119

Phone: (510) 337-7950

Specialties

Specialty Code Primary License
Counselor 101Y00000X Yes -

Frequently Asked Questions

NPI 1104545490 is the National Provider Identifier for TIMOTHY PETTETT, SUDRC #16547, a Counselor provider located in San Jose, CA. This NPI was enumerated on August 22, 2022.
TIMOTHY PETTETT, SUDRC #16547 practices at 298 BERNAL RD, San Jose, CA 95119.

Quick Facts

NPI
1104545490
Type
Individual
Enumerated
Aug 22, 2022
Last Updated
Oct 20, 2024

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