Provider Demographics
NPI:1447661368
Name:PETROV, SABRINA MARIE (LAC)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:MARIE
Last Name:PETROV
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:DR
Other - First Name:SABRINA
Other - Middle Name:
Other - Last Name:PETROV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:3364 BIG CUT RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6619
Mailing Address - Country:US
Mailing Address - Phone:530-919-6558
Mailing Address - Fax:
Practice Address - Street 1:419 MAIN ST STE 308
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5640
Practice Address - Country:US
Practice Address - Phone:530-919-6558
Practice Address - Fax:530-296-4789
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15687171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist