Healthcare Provider Details

I. General information

NPI: 1295101590
Provider Name (Legal Business Name): PETER MENDELSOHN M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S SPALDING DR SUITE 315
BEVERLY HILLS CA
90212-1800
US

IV. Provider business mailing address

5456 VALLEY RIDGE AVE
LOS ANGELES CA
90043-2231
US

V. Phone/Fax

Practice location:
  • Phone: 310-560-8806
  • Fax: 323-296-8673
Mailing address:
  • Phone: 323-296-8671
  • Fax: 323-296-8673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG65308
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG65308
License Number StateCA

VIII. Authorized Official

Name: DR. PETER MENDELSOHN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-560-8806