Louella Peckson, M.D., Inc.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

Legal business name

LOUELLA PECKSON, M.D., INC.

Practice address

14624 Sherman Way
Suite 401
Van Nuys, CA 91405-2241

Phone

(818) 786-1200

Fax

(818) 786-1201

NPI assigned

Jun 27, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Louella L Peckson, M.D.NPI 1467540021

Title

President

Phone

(818) 786-1200

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Louella Peckson, MD

  • Pediatrics Physician
  • Van Nuys, CA
  • NPI 1467540021
  NPD (past) Authorized official

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

{
    "created_epoch": "1309132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309132800000",
    "number": "1144516295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14624 SHERMAN WAY",
            "address_2": "SUITE 401",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914052241",
            "telephone_number": "818-786-1200",
            "fax_number": "818-786-1201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14624 SHERMAN WAY",
            "address_2": "SUITE 401",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914052241",
            "telephone_number": "818-786-1200",
            "fax_number": "818-786-1201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUELLA PECKSON, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-27",
        "last_updated": "2011-06-27",
        "status": "A",
        "authorized_official_last_name": "PECKSON",
        "authorized_official_first_name": "LOUELLA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-786-1200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A53093",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Adolescent Medicine Physician in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• Pediatric Adolescent Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2011; 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.