Healthcare Provider Details

I. General information

NPI: 1922242585
Provider Name (Legal Business Name): PATRICK PEZESHKIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 S BEVERLY GLEN BLVD SUITE 202
LOS ANGELES CA
90025-6075
US

IV. Provider business mailing address

2101 S BEVERLY GLEN BLVD SUITE 202
LOS ANGELES CA
90025-6075
US

V. Phone/Fax

Practice location:
  • Phone: 818-294-0125
  • Fax:
Mailing address:
  • Phone: 818-294-0125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: