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NPI Code Detail

MEDICARE: DR. LARRY MARC GERSTEN M.D.

MEDICARE: DR. LARRY MARC GERSTEN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XS0114XAdult Reconstructive Orthopaedic Surgery PhysicianG50397CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RR2000 19525OTHERCAMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
300G503970G89OTHERCACAL-OPTIMA

General Provider Information

NPI Number : 1417950064
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY MARC GERSTEN M.D.
Provider Business Mailing Address
First Line : 24331 EL TORO RD STE 200
Second Line :
City : LAGUNA WOODS
State : CA
Zip : 92637-3116
Country : US
Telephone Number : 949-586-3200
Fax Number : 949-900-2116
Provider Business Practice Location Address
First Line : 24331 EL TORO RD STE 200
Second Line :
City : LAGUNA WOODS
State : CA
Zip : 92637-3116
Country : US
Telephone Number : 949-586-3200
Fax Number : 949-900-2116
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 06/19/2020

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