Provider Demographics
NPI:1740337328
Name:CEPEDA, PEDRO J (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:J
Last Name:CEPEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3590 E IMPERIAL HWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2655
Mailing Address - Country:US
Mailing Address - Phone:310-631-4064
Mailing Address - Fax:310-631-4246
Practice Address - Street 1:3590 E IMPERIAL HWY
Practice Address - Street 2:SUITE 5
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2655
Practice Address - Country:US
Practice Address - Phone:310-631-4064
Practice Address - Fax:310-631-4246
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86266207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G862660Medicaid
CA00G862660Medicaid