Provider Demographics
NPI:1700858214
Name:AMPUDIA, PETER ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALBERT
Last Name:AMPUDIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3711 LOMITA BLVD
Mailing Address - Street 2:STE 127
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3877
Mailing Address - Country:US
Mailing Address - Phone:310-375-5757
Mailing Address - Fax:310-375-4547
Practice Address - Street 1:23700 CAMINO DEL SOL
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-530-1151
Practice Address - Fax:310-784-2230
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG720212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG720210Medicaid
CAG720210Medicaid