MEDICARE: GRIGORY DAVIDOVSKY

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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1659525715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRIGORY DAVIDOVSKY

Provider Business Mailing Address
First Line	:	1448 N SIERRA BONITA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4112
Country	:	US
Telephone Number	:	323-850-0578
Fax Number	:	323-297-5151

Provider Business Practice Location Address
First Line	:	1448 N SIERRA BONITA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4112
Country	:	US
Telephone Number	:	323-850-0578
Fax Number	:	323-297-5151

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2008
Last Update Date	:	12/29/2011

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Directions to “ GRIGORY DAVIDOVSKY ” Practice Location

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