Basic Information
| Provider Information | |||||||||
| NPI: | 1700858214 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMPUDIA | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | ALBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3711 LOMITA BLVD | ||||||||
| Address2: | STE 127 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905053877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103755757 | ||||||||
| FaxNumber: | 3103754547 | ||||||||
| Practice Location | |||||||||
| Address1: | 23700 CAMINO DEL SOL | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105301151 | ||||||||
| FaxNumber: | 3107842230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 06/27/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | G72021 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | G720210 | 05 | CA | MEDICAID |