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General NPI Number Information
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NPI Number | 1245530922
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Entity Type | Organization
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Legal Business Name | JACOB B PELTA MD
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Dates
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Enumeration Date | 10/27/2010
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Last Update Date | 10/27/2010
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Provider Practice Location Address
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Address Line | 6360 WILSHIRE BLVD SUITE # 501
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City | LOS ANGELES
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State | CA
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Zip | 90048-5603
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Country | US
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Telephone | 323-653-6166
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Fax | 323-653-6171
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Provider Business Mailing Address
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Address Line | 6360 WILSHIRE BLVD SUITE # 501
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City | LOS ANGELES
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State | CA
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Zip | 90048-5603
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Country | US
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Telephone | 323-656-3616
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Fax | 323-653-6171
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Authorized Official
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Title or Position | OWNER
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Name | JACOB B PELTA
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Credential | MD
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Telephone | 323-653-6166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | G23606
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G23606
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License Number State | CA
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