NPI 1427783315

Kristofer Kedar Pettway

Practitioner Prevention Professional Los Angeles, CA

Practice location

Address: 411 S Normade Ave APT 732, Los Angeles, CA 90020-3396
Phone: (516) 919-0061

Registered specialties

Prevention Professional Primary

Other Service Providers Taxonomy 405300000X Licence 19393832 (NY)

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Registry record

NPI: 1427783315
Entity type: Individual
Sex (as registered): Male
NPI issued: 23 Jul 2022
Record last updated: 23 Jul 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.