Provider Demographics
NPI:1154350320
Name:PEKAROVICS, SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:PEKAROVICS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6360 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5603
Mailing Address - Country:US
Mailing Address - Phone:323-951-4916
Mailing Address - Fax:323-951-4917
Practice Address - Street 1:6360 WILSHIRE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5603
Practice Address - Country:US
Practice Address - Phone:323-951-4916
Practice Address - Fax:323-951-4917
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56360207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA56360OtherLICENSE NUMBER
CAEY179ZOtherMEDICARE GROUP INDIVIDUAL PTAN
ALBP5114020OtherDEA
CAG38688Medicare UPIN
CAA56360AMedicare ID - Type Unspecified