Provider Demographics
NPI:1134168289
Name:PEARLMAN, JEFF
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:PEARLMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JEFFREY
Other - Middle Name:JAY
Other - Last Name:PEARLMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 661297
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-1297
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:2070 CENTURY PARK E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-1907
Practice Address - Country:US
Practice Address - Phone:310-772-4100
Practice Address - Fax:818-587-2493
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC40719207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA930101498OtherRAILROAD MEDICARE
CA00C407190OtherBLUE SHIELD
CA00C407190Medicaid
CAWC40719LMedicare PIN
CAWC40719KMedicare PIN
CA00C407190OtherBLUE SHIELD
CAE60773Medicare UPIN