| Bobby Pezeshki Md Inc | |
|
2011 Wilshire Blvd Ste 300 Los Angeles CA 90057-3503 | |
| (213) 413-2700 | |
| (213) 413-6722 |
| Full Name | Bobby Pezeshki Md Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2011 Wilshire Blvd Ste 300, Los Angeles, California |
| Authorized Official Name and Position | Babak Pezeshki (CEO/MEDICAL DIRECTOR) |
| Authorized Official Contact | 2134132700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bobby Pezeshki Md Inc 2007 Wilshire Blvd Ste 300 Los Angeles CA 90057-3506 Ph: (213) 413-2700 | Bobby Pezeshki Md Inc 2011 Wilshire Blvd Ste 300 Los Angeles CA 90057-3503 Ph: (213) 413-2700 |
| NPI Number | 1164999215 |
|---|---|
| Provider Enumeration Date | 10/26/2018 |
| Last Update Date | 11/15/2018 |
| Medicare PECOS PAC ID | 6608114442 |
|---|---|
| Medicare Enrollment ID | O20190412000666 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164999215 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Ethel S Dijamco |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1780750752 PECOS PAC ID: 8729075080 Enrollment ID: I20040428000871 |
| Provider Name | Michelle Misch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952479396 PECOS PAC ID: 7517091549 Enrollment ID: I20140707000136 |
| Provider Name | Babak Pezeshki |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710376926 PECOS PAC ID: 7416295258 Enrollment ID: I20190227000832 |
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