Provider Demographics
NPI:1831113802
Name:SAN PEDRO PENINSULA HOSPITAL
Entity Type:Organization
Organization Name:SAN PEDRO PENINSULA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUANICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-303-7496
Mailing Address - Street 1:PO BOX 541024
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90054-1024
Mailing Address - Country:US
Mailing Address - Phone:310-303-7496
Mailing Address - Fax:310-303-7575
Practice Address - Street 1:1300 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3505
Practice Address - Country:US
Practice Address - Phone:310-303-7496
Practice Address - Fax:310-303-7575
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN PEDRO PENINSULA HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-26
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05T078OtherBLUE CROSS
CA05T078Medicare Oscar/Certification