Provider Demographics
NPI:1043867971
Name:PEPPERDINE UNIVERSITY
Entity type:Organization
Organization Name:PEPPERDINE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHABILITATION COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIKO
Authorized Official - Last Name:ELBY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, SCS, ATC
Authorized Official - Phone:310-506-4169
Mailing Address - Street 1:24255 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90263-3999
Mailing Address - Country:US
Mailing Address - Phone:310-506-4316
Mailing Address - Fax:
Practice Address - Street 1:24255 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90263-3999
Practice Address - Country:US
Practice Address - Phone:310-506-4316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health