NPIMap

Organization Active NPI

Los Angeles County - San Pedro Mtu

  • Rehabilitation Clinic/Center
  • San Pedro, CA
National Provider Identifier
1982759304
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
LOS ANGELES COUNTY - SAN PEDRO MTU
Practice address
308 S Weymouth Ave
San Pedro, CA 90732-3426
Phone
(310) 833-9528
NPI assigned
Jan 24, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Shavonda Webber-Christmas
Title
Acting Director, CMS
Phone
(626) 569-6001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X NU Primary

Addresses

Primary practice location

308 S Weymouth Ave
San Pedro, CA 90732-3426

Mailing address

9320 Telstar Ave Ste 226
El Monte, CA 91731-2849

Other identifiers 1

IdentifierTypeStateIssuer
CCS00062FMedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Hudson Health Center613 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

Locations

308 S Weymouth Ave
San Pedro, CA 90732
Phone (310) 833-9528

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982759304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9320 TELSTAR AVE STE 226",
            "city": "EL MONTE",
            "state": "CA",
            "postal_code": "917312849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 S WEYMOUTH AVE",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323426",
            "telephone_number": "310-833-9528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOS ANGELES COUNTY - SAN PEDRO MTU",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WEBBER-CHRISTMAS",
        "authorized_official_first_name": "SHAVONDA",
        "authorized_official_title_or_position": "ACTING DIRECTOR, CMS",
        "authorized_official_telephone_number": "626-569-6001"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CCS00062F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Aug 22, 2020; 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.