Provider Demographics
NPI:1215460506
Name:ESTAKHRI, PEJMON PATRICK (MD)
Entity type:Individual
Prefix:
First Name:PEJMON
Middle Name:PATRICK
Last Name:ESTAKHRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PEJ
Other - Middle Name:
Other - Last Name:ESTAKHRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6121 N THESTA ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5294
Mailing Address - Country:US
Mailing Address - Phone:559-440-0283
Mailing Address - Fax:
Practice Address - Street 1:6121 N THESTA ST STE 202
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5294
Practice Address - Country:US
Practice Address - Phone:559-440-0283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA157582208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery