Provider Demographics
NPI:1083632699
Name:ABRAHAMS, PEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:PEZ
Middle Name:
Last Name:ABRAHAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S BROADWAY
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90014-1897
Mailing Address - Country:US
Mailing Address - Phone:213-244-9997
Mailing Address - Fax:213-244-9998
Practice Address - Street 1:621 S BROADWAY
Practice Address - Street 2:SUITE 306
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014-1897
Practice Address - Country:US
Practice Address - Phone:213-244-9997
Practice Address - Fax:213-244-9998
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71500208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A715000Medicaid
CAA71500Medicare ID - Type UnspecifiedPROVIDER NUMBER