=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437600772
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANIA MARIAM GAPELEH, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2016
-----------------------------------------------------
Last Update Date | 10/21/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5333 VELOZ AVE
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-4127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-882-8401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5333 VELOZ AVE
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-4127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | ANIA GAPELEH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-882-8401
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A133064
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------