Healthcare Provider Details

I. General information

NPI: 1043867971
Provider Name (Legal Business Name): PEPPERDINE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24255 PACIFIC COAST HWY
MALIBU CA
90263-3999
US

IV. Provider business mailing address

24255 PACIFIC COAST HWY
MALIBU CA
90263-3999
US

V. Phone/Fax

Practice location:
  • Phone: 310-506-4316
  • Fax:
Mailing address:
  • Phone: 310-506-4316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE MARIKO ELBY
Title or Position: REHABILITATION COORDINATOR
Credential: PT, DPT, SCS, ATC
Phone: 310-506-4169