Individual provider Active NPI

Maria Gultom

  • Cardiovascular Disease Physician
  • Los Angeles, CA
National Provider Identifier
1013391358
Registry record updated Jul 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
95002729 Issued in CA
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

Updated by the provider on Jul 7, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161215001824 CA Practitioner - Nurse Practitioner 4587960018 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
86713CAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
The Regents of the University of California Cardiovascular Disease CurrentSince May 3, 2020 Accepting new patients
The Regents of the University of California CurrentSince Feb 1, 2017 Accepting new patients
The Regents of the University of California CurrentSince May 3, 2020 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

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.