Healthcare Provider Details

I. General information

NPI: 1881056075
Provider Name (Legal Business Name): GORDON PELEGRIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 N BRENT ST STE 406
VENTURA CA
93003-2824
US

IV. Provider business mailing address

168 N BRENT ST STE 406
VENTURA CA
93003-2824
US

V. Phone/Fax

Practice location:
  • Phone: 805-653-6371
  • Fax:
Mailing address:
  • Phone: 805-653-6371
  • Fax: 718-652-8384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA179605
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: