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Organization
LA MEDIWAVE INC
Active
Organization
LA MEDIWAVE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GABRIEL RUBANENKO M.D. (OWNER)
(323) 965-5088
Entity
Organization
Contact information
Practice address
6200 WILSHIRE BLVD, SUITE 910, LOS ANGELES, CA 90048-5801
(323) 965-5088
(323) 965-1046
Mailing address
6200 WILSHIRE BLVD, SUITE 910, LOS ANGELES, CA 90048-5801
(323) 965-5088
(323) 965-1046
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
—
NULL
208VP0000X
Pain Medicine Physician
Primary
—
—
Other
Enumeration date
09/21/2010
Last updated
09/21/2010
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