Culver City Pediatrics

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G19153 Issued in CA

Legal business name

CULVER CITY PEDIATRICS

Practice address

9696 Culver Blvd
Suite 108
Culver City, CA 90232-2700

Phone

(310) 204-6897

NPI assigned

Feb 15, 2007

Organization subpart

No

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

Authorized official

Name

Jeffrey Penso, M.D.

Title

Owner

Phone

(310) 204-6897

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023151123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9696 CULVER BLVD",
            "address_2": "SUITE 108",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902322700",
            "telephone_number": "310-204-6897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9696 CULVER BLVD",
            "address_2": "SUITE 108",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902322700",
            "telephone_number": "310-204-6897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CULVER CITY PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PENSO",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-204-6897",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G19153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0102600",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edith M. Cuevas-Mendoza, D.M.D.
• Monica Culpepper
• Culver City Eye Institute, Inc.
• Culver City Health Center
• Culver City Operations West, LLC
• Culver City Psychological Associates, Inc.
• Culver City Specialty and Podiatry Group
• Culver City Surgical Center
• Culver City Surgical Specialists, Inc
• Culver City Usd

• Pediatrics Physician in Culver City, CA
• Providers in Culver City, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.