Active NPI
Maria Gultom
- Cardiovascular Disease Physician
- Los Angeles, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- 95002729
- Practice address
- 100 UCLA Medical PLZ Ste 630
Los Angeles, CA 90024-6997 - Phone
- (310) 794-1276
- NPI assigned
- Jul 16, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 95002729 | CA | |
| Cardiovascular Disease Physician | 207RC0000X | 95002729 | CA | Primary |
Addresses
Primary practice location
100 UCLA Medical PLZ Ste 630
Los Angeles, CA 90024-6997
Mailing address
5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631
Phone (310) 267-9536
Other practice location 1
757 Westwood Plz
Suite 7330F
Los Angeles, CA 90095-8358
Phone (310) 267-9536
Other practice location 2
757 Westwood Plz
Suite 7330F
Los Angeles, CA 90095-8358
Phone (310) 267-9536
Other practice location 3
10833 Le Conte Ave
Los Angeles, CA 90095-3075
Phone (310) 825-9820
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86713 | CA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Regents of the University of California | Cardiovascular Disease | Current | Accepting new patients |
| The Regents of the University of California | Current | Accepting new patients | |
| The Regents of the University of California | Current | Accepting new patients | |
| UCLA Medical Group | Cardiovascular Disease | Past | Accepting new patients |
Locations
24302 Paseo de Valencia
Ste 200
Laguna Hills, CA 92653
Phone (949) 458-8252
100 UCLA Medical Plz
Ste 630
Los Angeles, CA 90024
Phone (310) 825-8816
File 55737
Los Angeles, CA 90074
757 Westwood Plz
Ste 7330F
Los Angeles, CA 90095
Phone (310) 267-9536
5767 W Century Blvd
Ste 400
Los Angeles, CA 90045
Phone (310) 301-5200
File 54206
Los Angeles, CA 90074
100 Medical Plz
Los Angeles, CA 90095
Phone (310) 825-2631
10833 Le Conte Ave
Los Angeles, CA 90095
Phone (310) 301-8932
2020 Santa Monica Blvd
Ste 210
Santa Monica, CA 90404
Phone (310) 458-2381
100 Moody Ct
Ste 200
Thousand Oaks, CA 91360
Phone (805) 418-3500
Interoperability endpoints
- mgultom11848@direct.uclahealth.org
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Internal Medicine Physician
- Los Angeles, CA
- NPI 1235107566
Cardiovascular Disease
-
- Surgery Physician
- Los Angeles, CA
- NPI 1912963232
-
- Ambulatory Surgical Clinic/Center
- Valencia, CA
- NPI 1689200305
-
- Internal Medicine Physician
- Los Angeles, CA
- NPI 1043427248
Cardiovascular Disease
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594080000000",
"number": "1013391358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5767 W CENTURY BLVD STE 400",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900455631",
"telephone_number": "310-267-9536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 UCLA MEDICAL PLZ STE 630",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900246997",
"telephone_number": "310-794-1276"
}
],
"practiceLocations": [
{
"address_1": "757 Westwood Plz",
"address_2": "Suite 7330F",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900958358",
"country_code": "US",
"telephone_number": "310-267-9536",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "757 Westwood Plz",
"address_2": "Suite 7330F",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900958358",
"country_code": "US",
"telephone_number": "310-267-9536",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "10833 Le Conte Ave",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900953075",
"country_code": "US",
"telephone_number": "310-825-9820",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GULTOM",
"first_name": "MARIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-16",
"last_updated": "2020-07-07",
"certification_date": "2020-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "CA",
"license": "95002729",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "CA",
"license": "95002729",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.