Active NPI
Paola Pederzoli-Carrillo, NP
- Pediatric Rheumatology Physician
- Los Angeles, CA
National Provider Identifier
1639345150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Rheumatology Physician
- License
- 527692
- Practice address
- 10833 Le Conte Ave # 12-430
Los Angeles, CA 90095-3075 - Phone
- (310) 794-4065
- Fax
- (310) 825-9832
- NPI assigned
- May 5, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Rheumatology Physician | 2080P0216X | 527692 | CA | Primary |
Addresses
Primary practice location
10833 Le Conte Ave # 12-430
Los Angeles, CA 90095-3075
Mailing address
10833 Le Conte Ave # 12-430
Los Angeles, CA 90095-7901
Phone (310) 794-4065
Other practice location 1
200 UCLA Medical Plaza Ste 265
Los Angeles, CA 90095-8344
Phone (310) 825-0867
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 527692 | CA | MD | Pediatric Rheumatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Hospital Los Angeles | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Children's Chronic Disease Hospital
- Los Angeles, CA
- NPI 1366527954
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626825600000",
"number": "1639345150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10833 LE CONTE AVE # 12-430",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900957901",
"telephone_number": "310-794-4065",
"fax_number": "310-825-9832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10833 LE CONTE AVE # 12-430",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900953075",
"telephone_number": "310-794-4065",
"fax_number": "310-825-9832"
}
],
"practiceLocations": [
{
"address_1": "200 UCLA Medical Plaza Ste 265",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900958344",
"country_code": "US",
"telephone_number": "310-825-0867",
"fax_number": "310-825-9832",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PEDERZOLI-CARRILLO",
"first_name": "PAOLA",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-05",
"last_updated": "2021-07-21",
"certification_date": "2021-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0216X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Rheumatology",
"state": "CA",
"license": "527692",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.