Individual provider Active NPI

Celena Derderian Pentagulio

  • Psychiatry Physician
  • Ventura, CA
National Provider Identifier
1790312783
Registry record updated Oct 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A178633 Issued in CA
Practice address
300 Hillmont Ave
Ventura, CA 93003-1651
Phone
(805) 652-6000
NPI assigned
Mar 27, 2020
Last updated
Oct 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X A178633 CA Primary

Addresses

Primary practice location

300 Hillmont Ave
Ventura, CA 93003-1651

Mailing address

1200 N State Street Clinic Tower
Suite A7D
Los Angeles, CA 90033-1029
Phone (323) 409-5555

Other practice location 1

1200 N State Street Clinic Tower
Suite A7D
Los Angeles, CA 90033-1029
Phone (323) 409-5555

Other practice location 2

200 Hillmont Ave
Ventura, CA 93003-1647
Phone (805) 652-6729

Other names 1

  • Celena Joyce Derderian Professional name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address celena.pentaguilio@ventura.cernerdirect.com Direct
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231211002635 CA Practitioner - Psychiatry 5991105348 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Creighton University School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Regeneration PsychiatryGroup PAC ID 3072911122, 13 clinicians

Practice addresses (Care Compare)

1294 W 6TH St
FL 2
San Pedro, CA 90731-2987
Phone (310) 519-6100

2512 Artesia Blvd
Suite 320
Redondo Beach, CA 90278-3282
Phone (424) 277-2899

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A178633CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regeneration Psychiatry Psychiatry CurrentSince Jul 1, 2024 Accepting new patients
Southern California Permanente Medical Group CurrentSince Oct 2, 2023 Accepting new patients
Southern California Permanente Medical Group CurrentSince Oct 2, 2023 Accepting new patients
Rebecca Salamo MD Inc Psychiatry CurrentSince Apr 27, 2025 Accepting new patients
County of Ventura CurrentSince Jul 1, 2025 Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Sep 22, 2025 Accepting new patients
County of Ventura Current Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Sep 22, 2025 Accepting new patients
County of Ventura CurrentSince Jul 1, 2025 Accepting new patients

Locations

43112 15th St W
Lancaster, CA 93534
Phone (661) 726-2222

510 S Vermont Ave
Fl 19
Los Angeles, CA 90020
Phone (213) 480-3416

13652 Cantara St
Panorama City, CA 91402
Phone (818) 375-2417

393 E Walnut St
Fl 5
Pasadena, CA 91188
Phone (310) 403-3235

2512 Artesia Blvd
Ste 310
Redondo Beach, CA 90278
Phone (310) 323-6767

2512 Artesia Blvd
Ste 320
Redondo Beach, CA 90278
Phone (424) 277-2899

1294 W 6th St
Fl 2
San Pedro, CA 90731
Phone (310) 519-6100

200 Hillmont Ave
Ventura, CA 93003
Phone (805) 652-5755

300 Hillmont Ave
Ventura, CA 93003
Phone (805) 652-6000

800 S Victoria Ave
#L4640
Ventura, CA 93009

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: celena.pentaguilio@ventura.cernerdirect.com
  • Direct secure messaging: celena.pentagulio.1@24050.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/24050/brand/1/csg/1/fhir/r4

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1585267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760486400000",
    "number": "1790312783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N STATE STREET CLINIC TOWER",
            "address_2": "SUITE A7D",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900331029",
            "telephone_number": "323-409-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 HILLMONT AVE",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930031651",
            "telephone_number": "805-652-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 N State Street Clinic Tower",
            "address_2": "Suite A7D",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900331029",
            "country_code": "US",
            "telephone_number": "323-409-5555",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Hillmont Ave",
            "address_purpose": "LOCATION",
            "city": "Ventura",
            "state": "CA",
            "postal_code": "930031647",
            "country_code": "US",
            "telephone_number": "805-652-6729",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENTAGULIO",
        "first_name": "CELENA",
        "middle_name": "DERDERIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-27",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A178633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "celena.pentaguilio@ventura.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Cerner Direct Secure Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Information",
            "address_1": "300 Hillmont Ave",
            "city": "Ventura",
            "state": "CA",
            "country_code": "US",
            "postal_code": "930031651",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "43112 15th St W",
            "city": "Lancaster",
            "state": "CA",
            "country_code": "US",
            "postal_code": "935346219",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CELENA",
            "last_name": "DERDERIAN",
            "middle_name": "JOYCE",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Ventura, CA

Sources for this page

Verify at the official NPI Registry.