Provider Demographics
NPI:1306435102
Name:ELSOUSOU, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:ELSOUSOU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9808 VENICE BLVD STE 505
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-6818
Practice Address - Country:US
Practice Address - Phone:310-945-3350
Practice Address - Fax:310-945-3356
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner