Healthcare Provider Details

I. General information

NPI: 1598817868
Provider Name (Legal Business Name): MEHRY GHARIB M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E WASHINGTON BLVD
LOS ANGELES CA
90015-3606
US

IV. Provider business mailing address

16157 ANOKA DR
PACIFIC PALISADES CA
90272-2413
US

V. Phone/Fax

Practice location:
  • Phone: 213-234-5520
  • Fax: 213-234-5521
Mailing address:
  • Phone: 310-454-0875
  • Fax: 213-234-5521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA53533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: