Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | A136215 | CA |
NPI | 1841633575 |
---|---|
Provider Name | Ajay Gurbani |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Santa Monica, CA 90404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2013 |
Last Update Date | 14/10/2019 |