Healthcare Provider Details
I. General information
NPI: 1649061581
Provider Name (Legal Business Name): PEAR SUITE PROVIDER GROUP CA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5250 LANKERSHIM BLVD STE 500
NORTH HOLLYWOOD CA
91601-3187
US
IV. Provider business mailing address
5250 LANKERSHIM BLVD STE 500
NORTH HOLLYWOOD CA
91601-3187
US
V. Phone/Fax
- Phone: 213-277-7340
- Fax:
- Phone: 213-277-7340
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208D00000X |
| Taxonomy | General Practice Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
VIKRAM
BAKHRU
Title or Position: PRESIDENT
Credential: MD
Phone: 213-277-7340