Provider Demographics
NPI:1982437935
Name:GAVALYAN, GEORGY
Entity type:Individual
Prefix:
First Name:GEORGY
Middle Name:
Last Name:GAVALYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 CRENSHAW BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1200
Mailing Address - Country:US
Mailing Address - Phone:323-290-8360
Mailing Address - Fax:
Practice Address - Street 1:4401 CRENSHAW BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-1200
Practice Address - Country:US
Practice Address - Phone:323-290-8360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program