Healthcare Provider Details

I. General information

NPI: 1942264015
Provider Name (Legal Business Name): GARY E FALKOFF I MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 BRUNKEN AVE SUITE A
SALINAS CA
93901-5002
US

IV. Provider business mailing address

PO BOX 190
SIMI VALLEY CA
93062-0190
US

V. Phone/Fax

Practice location:
  • Phone: 831-796-3740
  • Fax: 831-751-6393
Mailing address:
  • Phone: 805-577-2021
  • Fax: 805-577-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG597570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: