NPIMap

Organization Active NPI

San Pedro Peninsula Hospital

Doing business as San Pedro Peninsula Pavilion

  • Skilled Nursing Facility
  • San Pedro, CA
National Provider Identifier
1750305116
Registry record updated Apr 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SAN PEDRO PENINSULA HOSPITAL
Doing business as
San Pedro Peninsula Pavilion
Practice address
1322 W 6TH St
San Pedro, CA 90732-3501
Phone
(310) 303-7496
Fax
(310) 303-7575
NPI assigned
Jul 27, 2006
Last updated
Apr 27, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2009

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

Authorized official

Name
Mrs. Elizabeth Zuanich
Title
Cfo
Phone
(310) 303-7496

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1322 W 6TH St
San Pedro, CA 90732-3501

Mailing address

PO Box 6668
San Pedro, CA 90734-6668
Phone (310) 303-7496

Other identifiers 4

IdentifierTypeStateIssuer
LTX06297GMedicaidCA
056297OtherCABLUE CROSS PROV#
ZZT06297GMedicaidCA
ZZZM1977BOtherCABLUE SHIELD PROV#

Other names 1

  • San Pedro Peninsula Pavilion Doing business as

National Provider Directory

National Provider Directory
Tax ID family
San Pedro Peninsula Hospital4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240790400000",
    "number": "1750305116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6668",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907346668",
            "telephone_number": "310-303-7496",
            "fax_number": "310-303-7575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1322 W 6TH ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323501",
            "telephone_number": "310-303-7496",
            "fax_number": "310-303-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN PEDRO PENINSULA HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2009-04-27",
        "status": "A",
        "authorized_official_last_name": "ZUANICH",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "310-303-7496",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTX06297G",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROV#",
            "identifier": "056297",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT06297G",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROV#",
            "identifier": "ZZZM1977B",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Pedro Peninsula Pavilion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Pedro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2009; 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.