Individual
GRANT PEZESHKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1348 VIRGINIA ST, BERKELEY, CA 94702-1467
(718) 857-8729
Mailing address
1348 VIRGINIA ST, BERKELEY, CA 94702-1467
(718) 857-8729
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
174400000X
Specialist
—
—
Other
Enumeration date
02/09/2022
Last updated
02/11/2022
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