Provider Demographics
NPI:1669470068
Name:SHIRAZY, PEJMAN ELI (MD)
Entity Type:Individual
Prefix:
First Name:PEJMAN
Middle Name:ELI
Last Name:SHIRAZY
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 1:16952 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4197
Mailing Address - Country:US
Mailing Address - Phone:818-789-3964
Mailing Address - Fax:818-789-3967
Practice Address - Street 1:16952 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4197
Practice Address - Country:US
Practice Address - Phone:818-789-3964
Practice Address - Fax:818-789-3967
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA761002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA76100AMedicare PIN
CA5157130001Medicare NSC