Healthcare Provider Details

I. General information

NPI: 1164999215
Provider Name (Legal Business Name): BOBBY PEZESHKI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 WILSHIRE BLVD STE 300
LOS ANGELES CA
90057-3503
US

IV. Provider business mailing address

2007 WILSHIRE BLVD STE 300
LOS ANGELES CA
90057-3506
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-2700
  • Fax: 213-413-6722
Mailing address:
  • Phone: 213-413-2700
  • Fax: 213-413-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BABAK PEZESHKI
Title or Position: CEO/MEDICAL DIRECTOR
Credential: MD
Phone: 213-413-2700