Healthcare Provider Details

I. General information

NPI: 1215921044
Provider Name (Legal Business Name): MARC J. GIRSKY MD INC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S GRAND AVE SUITE 615
LOS ANGELES CA
90015-3048
US

IV. Provider business mailing address

1400 S GRAND AVE SUITE 615
LOS ANGELES CA
90015-3048
US

V. Phone/Fax

Practice location:
  • Phone: 213-748-0110
  • Fax: 213-748-0160
Mailing address:
  • Phone: 213-748-0110
  • Fax: 213-748-0160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberG83112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: