Individual
DR. GARY REZNIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6333 WILSHIRE BLVD, #200, LOS ANGELES, CA 90048
(323) 653-2504
(323) 653-2505
Mailing address
6333 WILSHIRE BLVD, #200, LOS ANGELES, CA 90048
(323) 653-2504
(323) 653-2515
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G67314A
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215114251
—
CA
01
—
W21850
MEDICARE GROUP PTAN
CA
01
—
WG67314F
MEDICARE INDIVIDUAL PTAN
CA
Enumeration date
07/11/2006
Last updated
07/22/2010
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