Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | A55235 | CA |
NPI | 1053368472 |
---|---|
Provider Name | Dr. Joseph Carl Peck |
First Address | Manhattan Beach, CA 90266-2470 |
Second Address | Manhattan Beach, CA 90266-2470 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 18/01/2022 |