Provider Demographics
NPI:1528105277
Name:MIZRAJI, GABRIEL MARCOS (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:MARCOS
Last Name:MIZRAJI
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:5330 E EL PRADO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-3909
Mailing Address - Country:US
Mailing Address - Phone:562-498-7337
Mailing Address - Fax:
Practice Address - Street 1:550 DEEP VALLEY DR STE 345
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-7603
Practice Address - Country:US
Practice Address - Phone:310-377-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA362641223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223P0221XDental ProvidersDentistPediatric Dentistry