Organization
KEITH L. GURNICK, D.P.M.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH LOUIS GURNICK D.P.M. (OWNER)
(310) 553-7691
Entity
Organization
Contact information
Practice address
2080 CENTURY PARK E, SUITE 705, LOS ANGELES, CA 90067-2001
(310) 553-7691
(310) 553-9542
Mailing address
2080 CENTURY PARK E, SUITE 705, LOS ANGELES, CA 90067-2001
(310) 553-7691
(310) 553-9542
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
E2615A
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000E2615000
BLUE SHIELD
CA
01
—
P1737210
OXFORD
CA
Enumeration date
10/04/2016
Last updated
10/04/2016
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