Look up the most recent NPI and PECOS records

Celena Derderian Pentagulio

Psychiatry & Neurology

Allopathic & Osteopathic Physicians

1200 N State Street Clinic Tower, Suite A7d, Los Angeles, CA 90033-1029

PECOS Enrollment

This provider is enrolled in PECOS as CELENA PENTAGULIO.

Based on the most recent information from CMS, provider Celena Derderian Pentagulio is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1790312783
Provider Type
Individual
Full Name
Pentagulio, Celena Derderian
Gender
Female

Sole Proprietor
No
Enumeration Date
3/27/2020
Last Updated
12/26/2023

Contact Information

Practice Location

1200 N State Street Clinic Tower, Suite A7d, Los Angeles, CA 90033-1029

(323) 409-5555

Unlisted Fax

Mailing Location

1200 N State Street Clinic Tower, Suite A7d, Los Angeles, CA 90033-1029

(323) 409-5555

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 2084P0800X Primary	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License A178633 California
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Celena Derderian Pentagulio

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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