Active NPI
Peter Elsousou
- Rehabilitation Practitioner
- Culver City, CA
National Provider Identifier
1306435102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 9808 Venice Blvd Ste 505
Culver City, CA 90232-6818 - Phone
- (310) 945-3350
- Fax
- (310) 945-3356
- NPI assigned
- Jan 15, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | Primary |
Addresses
Primary practice location
9808 Venice Blvd Ste 505
Culver City, CA 90232-6818
Mailing address
75 Jordan Ave
Ventura, CA 93001-3509
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673481600000",
"number": "1306435102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 JORDAN AVE",
"city": "VENTURA",
"state": "CA",
"postal_code": "930013509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9808 VENICE BLVD STE 505",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902326818",
"telephone_number": "310-945-3350",
"fax_number": "310-945-3356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELSOUSOU",
"first_name": "PETER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-01-15",
"last_updated": "2023-01-12",
"certification_date": "2023-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Culver City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.