Active NPI
Mark Jonifer De Peralta Martinez
- Pharmacist
- Culver City, CA
National Provider Identifier
1952904567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 82408
- Practice address
- 3515 Helms Ave
Culver City, CA 90232-2414 - Phone
- (310) 559-5903
- NPI assigned
- Nov 17, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 82408 | CA | Primary |
Addresses
Primary practice location
3515 Helms Ave
Culver City, CA 90232-2414
Mailing address
15540 Moorpark St.
Los Angeles, CA 91436
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 |
|---|---|---|---|
| 82408 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640908800000",
"number": "1952904567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15540 MOORPARK ST.",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "91436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3515 HELMS AVE",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902322414",
"telephone_number": "310-559-5903"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINEZ",
"first_name": "MARK JONIFER",
"middle_name": "DE PERALTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-17",
"last_updated": "2021-12-31",
"certification_date": "2021-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "82408",
"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 Dec 31, 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.