Healthcare Provider Details

I. General information

NPI: 1164200739
Provider Name (Legal Business Name): ARIEL GAVINO M.D. A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 BELLINGHAM AVE STE 2
NORTH HOLLYWOOD CA
91606-1402
US

IV. Provider business mailing address

6440 BELLINGHAM AVE STE 2
NORTH HOLLYWOOD CA
91606-1402
US

V. Phone/Fax

Practice location:
  • Phone: 818-860-4330
  • Fax: 818-860-4331
Mailing address:
  • Phone: 818-860-4330
  • Fax: 818-860-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ARIEL GAVINO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 818-860-4330