Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | G22339 | CA |
NPI | 1104936756 |
---|---|
Provider Name | Gary Rachelefsky |
First Address | Los Angeles, CA 90095-3675 |
Second Address | Los Angeles, CA 90095-8344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 16/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G223390 | (05) | CA |
A41546 | (02) | CA |