Stephanie Prudencio, DO in Los Angeles, CA

Stephanie Prudencio, DO is a medicare enrolled "Pediatrics" physician in Los Angeles, California. Her current practice location is 4650 W Sunset Blvd # 94, Los Angeles, California. You can reach out to her office (for appointments etc.) via phone at (323) 361-5115.

Stephanie Prudencio is licensed to practice in Florida (license number OS18629) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1699235200.

Contact Information

	Stephanie Prudencio, DO
	4650 W Sunset Blvd # 94, Los Angeles, CA 90027-6062
	(323) 361-5115
	Not Available

Map and Direction

Physician's Profile

Full Name	Stephanie Prudencio
Gender	Female
Speciality	Pediatrics
Location	4650 W Sunset Blvd # 94, Los Angeles, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1699235200
Provider Enumeration Date: 03/20/2019
Last Update Date: 06/13/2022

Medicare PECOS Information:

PECOS PAC ID: 4880036300
Enrollment ID: I20240529001310

Medical Identifiers

Medical identifiers for Stephanie Prudencio such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1699235200	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
208000000X	Pediatrics	UO6695 (Florida)	Secondary
390200000X	Student In An Organized Health Care Education/training Program	UO6695 (Florida)	Secondary
208000000X	Pediatrics	OS18629 (Florida)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Stephanie Prudencio allows following entities to bill medicare on her behalf.

Entity Name	Sacred Heart Health System Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1144271586 PECOS PAC ID: 3779491386 Enrollment ID: O20031125000699

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Stephanie Prudencio is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Stephanie Prudencio, DO 4650 W Sunset Blvd # 94, Los Angeles, CA 90027-6062 Ph: (323) 361-5115	Stephanie Prudencio, DO 4650 W Sunset Blvd # 94, Los Angeles, CA 90027-6062 Ph: (323) 361-5115

Reviews and Comments

Pediatrics Doctors in Los Angeles, CA

Dr. Mark Hendrik Corden, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 4650 W Sunset Blvd, Los Angeles, CA 90027 Phone: 323-361-8893 Fax: 323-361-1814
Ms. Roberta Miyeko Kato, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 4650 W Sunset Blvd, Los Angeles, CA 90027 Phone: 323-361-2101 Fax: 323-361-1355
Meera Dhirubhai Kanani, D.O. Pediatrics Medicare: Medicare Enrolled Practice Location: 1240 N Mission Rd, Los Angeles, CA 90033 Phone: 323-226-3691
Dr. Marisa Danbee Oh, D.O. Pediatrics Medicare: Medicare Enrolled Practice Location: 2020 Zonal Ave, Lac-usc Med Ctr- Interns/residents Building, Room 112, Los Angeles, CA 90089 Phone: 626-241-0704
Dr. Tiffany Prugpichailers Pedigo, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 757 Westwood Plz, B711 Rrumc, Los Angeles, CA 90095 Phone: 310-267-9129
Neema Izadi, MD, MS Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 4650 W Sunset Blvd # 75, Los Angeles, CA 90027 Phone: 323-361-2501 Fax: 323-361-1191
Jennifer Stephanie Menjivar-lopez, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 3671 W 6th St Ste A, Los Angeles, CA 90020 Phone: 213-235-2500

Stephanie Prudencio, DO - Medicare Pediatrics in Los Angeles, CA