Healthcare Provider Details

I. General information

NPI: 1891643920
Provider Name (Legal Business Name): CIRCUMCISION SPECIALIST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9808 VENICE BLVD STE 602
CULVER CITY CA
90232-6807
US

IV. Provider business mailing address

9808 VENICE BLVD STE 602
CULVER CITY CA
90232-6807
US

V. Phone/Fax

Practice location:
  • Phone: 310-559-8000
  • Fax:
Mailing address:
  • Phone: 310-559-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JEROME S PITTMAN
Title or Position: PRESIDENT
Credential:
Phone: 310-559-8000