Organization
GARY REZNIK M. D. INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY REZNIK M.D. (PRESIDENT)
(323) 653-2504
Entity
Organization
Contact information
Practice address
6333 WILSHIRE BLVD STE 200, LOS ANGELES, CA 90048-5724
(323) 653-2504
(323) 653-2515
Mailing address
6333 WILSHIRE BLVD STE 200, LOS ANGELES, CA 90048-5724
(323) 653-2504
(323) 653-2515
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G67314
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215114251
—
CA
01
—
W21850
MEDICARE GROUP PTAN
—
01
—
WG67314F
MEDICARE INDIVIDUAL PTAN
CA
Enumeration date
01/22/2008
Last updated
05/31/2012
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