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General NPI Number Information
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NPI Number | 1144777590
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Entity Type | Organization
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Legal Business Name | OLEG M. GAVRILYUK, M.D., PC
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 6699 ALVARADO RD #2302
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City | SAN DIEGO
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State | CA
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Zip | 92120-5244
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Country | US
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Telephone | 619-764-0330
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Fax |
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Provider Business Mailing Address
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Address Line | 6699 ALVARADO RD #2302
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City | SAN DIEGO
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State | CA
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Zip | 92120-5244
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | OLEG M GAVRILYUK
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Credential | M.D.
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Telephone | 619-764-0330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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