MEDICARE: DR. JOSEPH CARL PECK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	A55235	CA

General Provider Information

NPI Number	:	1053368472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH CARL PECK M.D.

Provider Business Mailing Address
First Line	:	1200 ROSECRANS AVE STE 202
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2470
Country	:	US
Telephone Number	:	310-618-9922
Fax Number	:	888-618-2660

Provider Business Practice Location Address
First Line	:	1200 ROSECRANS AVE STE 202
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2470
Country	:	US
Telephone Number	:	310-618-9922
Fax Number	:	888-618-2660

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	06/02/2023

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