Provider Demographics
NPI:1407908619
Name:PEZ ABRAHAMS, M.D.
Entity Type:Organization
Organization Name:PEZ ABRAHAMS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-888-4063
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:818-888-4063
Mailing Address - Fax:818-888-4064
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:818-888-4063
Practice Address - Fax:818-888-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71500208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A715000Medicaid
CA00A715000Medicaid