Provider Demographics
NPI:1609827336
Name:ILBEIGI, PEDRAM (DO)
Entity type:Individual
Prefix:DR
First Name:PEDRAM
Middle Name:
Last Name:ILBEIGI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18400 US HIGHWAY 18
Mailing Address - Street 2:SUITE A
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2306
Mailing Address - Country:US
Mailing Address - Phone:760-242-3939
Mailing Address - Fax:
Practice Address - Street 1:18400 US HIGHWAY 18
Practice Address - Street 2:SUITE A
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2306
Practice Address - Country:US
Practice Address - Phone:760-242-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07385700208800000X
CA20A8878208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI53560Medicare UPIN
CAAY511ZMedicare PIN
CAAY511YMedicare PIN
CAAY511ZMedicare PIN