Healthcare Provider Details

I. General information

NPI: 1750305116
Provider Name (Legal Business Name): SAN PEDRO PENINSULA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 W 6TH ST
SAN PEDRO CA
90732-3501
US

IV. Provider business mailing address

PO BOX 6668
SAN PEDRO CA
90734-6668
US

V. Phone/Fax

Practice location:
  • Phone: 310-303-7496
  • Fax: 310-303-7575
Mailing address:
  • Phone: 310-303-7496
  • Fax: 310-303-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH ZUANICH
Title or Position: CFO
Credential:
Phone: 310-303-7496