Provider Demographics
NPI:1053368472
Name:PECK, JOSEPH CARL (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CARL
Last Name:PECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1200 ROSECRANS AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2470
Mailing Address - Country:US
Mailing Address - Phone:310-618-9922
Mailing Address - Fax:888-618-2660
Practice Address - Street 1:1200 ROSECRANS AVE STE 202
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2470
Practice Address - Country:US
Practice Address - Phone:310-618-9922
Practice Address - Fax:888-618-2660
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA552352081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA55235CMedicare PIN
CAH10074Medicare UPIN