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General NPI Number Information
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NPI Number | 1477664217
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Entity Type | Individual
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Provider Name | JACOB B PELTA MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 10/04/2010
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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 | 323-653-6166
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Fax | 323-653-6171
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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