Basic Information
| Provider Information | |||||||||
| NPI: | 1295101590 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PETER MENDELSOHN M D INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5456 VALLEY RIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900432231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232968671 | ||||||||
| FaxNumber: | 3232968673 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 S SPALDING DR | ||||||||
| Address2: | SUITE 315 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902121800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105608806 | ||||||||
| FaxNumber: | 3232968673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2015 | ||||||||
| LastUpdateDate: | 12/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | MENDELSOHN | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3105608806 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | G65308 | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | G65308 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.