Healthcare Provider Details

I. General information

NPI: 1043312671
Provider Name (Legal Business Name): IRENE GILGOFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 IMPERIAL HWY
DOWNEY CA
90242-3456
US

IV. Provider business mailing address

PO BOX 30220
LOS ANGELES CA
90030-0220
US

V. Phone/Fax

Practice location:
  • Phone: 562-803-0124
  • Fax: 562-803-5569
Mailing address:
  • Phone: 562-803-0124
  • Fax: 562-803-5569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG40728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: