Organization
CULVER CITY PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY PENSO M.D. (OWNER)
(310) 204-6897
Entity
Organization
Contact information
Practice address
9696 CULVER BLVD, SUITE 108, CULVER CITY, CA 90232-2700
(310) 204-6897
Mailing address
9696 CULVER BLVD, SUITE 108, CULVER CITY, CA 90232-2700
(310) 204-6897
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G19153
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0102600
—
CA
Enumeration date
02/15/2007
Last updated
08/22/2020
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