Healthcare Provider Details

I. General information

NPI: 1659200723
Provider Name (Legal Business Name): MARIA PEZZULO MA, ABAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 SANTO TOMAS DR
LOS ANGELES CA
90008-3304
US

IV. Provider business mailing address

4000 SANTO TOMAS DR
LOS ANGELES CA
90008-3304
US

V. Phone/Fax

Practice location:
  • Phone: 323-293-0985
  • Fax:
Mailing address:
  • Phone: 323-293-0985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU1027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: