Healthcare Provider Details

I. General information

NPI: 1336391960
Provider Name (Legal Business Name): GABRIEL G. PAI, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 MONTROSE AVE SUITE D
MONTROSE CA
91020-1546
US

IV. Provider business mailing address

10001 VENICE BLVD UNIT 402
LOS ANGELES CA
90034-6493
US

V. Phone/Fax

Practice location:
  • Phone: 818-957-2066
  • Fax:
Mailing address:
  • Phone: 310-818-5718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA86139
License Number StateCA

VIII. Authorized Official

Name: GABRIEL GARBIC PAI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-818-5718