| Peninsula Healthcare Center | |
|
22330 Hawthorne Blvd Ste 208 Torrance CA 90505-2536 | |
| (877) 354-1171 | |
| (424) 488-3600 |
| Full Name | Peninsula Healthcare Center |
|---|---|
| Speciality | General Practice |
| Location | 22330 Hawthorne Blvd Ste 208, Torrance, California |
| Authorized Official Name and Position | Shelly Calhoun (CEO) |
| Authorized Official Contact | 8773541171 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peninsula Healthcare Center 22330 Hawthorne Blvd Ste 208 Torrance CA 90505-2536 Ph: (877) 354-1171 | Peninsula Healthcare Center 22330 Hawthorne Blvd Ste 208 Torrance CA 90505-2536 Ph: (877) 354-1171 |
| NPI Number | 1235738782 |
|---|---|
| Provider Enumeration Date | 10/25/2020 |
| Last Update Date | 10/25/2020 |
| Medicare PECOS PAC ID | 5799197877 |
|---|---|
| Medicare Enrollment ID | O20210526001194 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235738782 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 363LP2300X | Nurse Practitioner - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Kevin B Calhoun |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1144239401 PECOS PAC ID: 6901103548 Enrollment ID: I20160404000801 |
| Provider Name | Shelly Calhoun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902418577 PECOS PAC ID: 8325450406 Enrollment ID: I20210528002029 |
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