Provider Demographics
NPI:1326228925
Name:MANOOCHEHRI, PEJ (DO)
Entity Type:Individual
Prefix:
First Name:PEJ
Middle Name:
Last Name:MANOOCHEHRI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N STATE ST
Mailing Address - Street 2:UNIT 1, ROOM 1011
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1029
Mailing Address - Country:US
Mailing Address - Phone:323-226-6667
Mailing Address - Fax:323-226-6454
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:UNIT 1, ROOM 1011
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1029
Practice Address - Country:US
Practice Address - Phone:323-226-6667
Practice Address - Fax:323-226-6454
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9725207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine