Provider Demographics
NPI:1851501290
Name:GAMARNIK, RAISA
Entity type:Individual
Prefix:
First Name:RAISA
Middle Name:
Last Name:GAMARNIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 516
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5701
Mailing Address - Country:US
Mailing Address - Phone:323-655-9877
Mailing Address - Fax:323-655-5199
Practice Address - Street 1:6363 WILSHIRE BLVD
Practice Address - Street 2:SUITE 516
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5701
Practice Address - Country:US
Practice Address - Phone:323-655-9877
Practice Address - Fax:323-655-5199
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG076Medicare PIN