Provider Demographics
NPI:1487217915
Name:GOEL, PEDRAM
Entity Type:Individual
Prefix:
First Name:PEDRAM
Middle Name:
Last Name:GOEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S MANCHESTER AVE STE 650
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3224
Mailing Address - Country:US
Mailing Address - Phone:714-456-5253
Mailing Address - Fax:
Practice Address - Street 1:200 S MANCHESTER AVE STE 650
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3224
Practice Address - Country:US
Practice Address - Phone:714-456-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program