Active NPI
Mary Katherine Maddock
- Psychiatric/Mental Health Nurse Practitioner
- Culver City, CA
National Provider Identifier
1457790594
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 23327
- Practice address
- 9808 Venice Blvd
Suite 700
Culver City, CA 90232-2732 - Phone
- (310) 945-3350
- Fax
- (310) 945-3356
- NPI assigned
- Jun 21, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 23327 | CA | Primary |
Addresses
Primary practice location
9808 Venice Blvd
Suite 700
Culver City, CA 90232-2732
Mailing address
9808 Venice Blvds
Suite 700
Culver City, CA 90232
Phone (310) 945-3350
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23327 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637884800000",
"number": "1457790594",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9808 VENICE BLVDS",
"address_2": "SUITE 700",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "90232",
"telephone_number": "310-945-3350",
"fax_number": "310-945-3356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9808 VENICE BLVD",
"address_2": "SUITE 700",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902322732",
"telephone_number": "310-945-3350",
"fax_number": "310-945-3356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADDOCK",
"first_name": "MARY",
"middle_name": "KATHERINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-06-21",
"last_updated": "2021-11-26",
"certification_date": "2021-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "CA",
"license": "23327",
"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 Nov 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.