Provider Demographics
NPI:1336210954
Name:BEHROUZI, PEJMAN P (DC)
Entity Type:Individual
Prefix:DR
First Name:PEJMAN
Middle Name:P
Last Name:BEHROUZI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 S COAST HIGHWAY 101 STE A
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3552
Mailing Address - Country:US
Mailing Address - Phone:760-487-5212
Mailing Address - Fax:760-487-5213
Practice Address - Street 1:345 S COAST HIGHWAY 101 STE A
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3552
Practice Address - Country:US
Practice Address - Phone:760-487-5212
Practice Address - Fax:760-487-5213
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23741111N00000X
CADC 23741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor