Provider Demographics
NPI:1104942887
Name:GARAYCOCHEA, CHRISTIAN ISRAEL (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:ISRAEL
Last Name:GARAYCOCHEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3153 E WARM SPRINGS RD #300
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120
Mailing Address - Country:US
Mailing Address - Phone:702-487-6510
Mailing Address - Fax:702-405-7960
Practice Address - Street 1:322 KAREN AVE
Practice Address - Street 2:UNIT 1207
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-0412
Practice Address - Country:US
Practice Address - Phone:801-368-0468
Practice Address - Fax:801-880-3841
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90223208D00000X, 207L00000X
NV13797207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A902230OtherBLUE SHIELD OF CALIFORNIA
CA00A902230Medicaid
CA00A902231Medicare PIN
CA00A902230Medicaid