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General NPI Number Information
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NPI Number | 1528105277
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Entity Type | Individual
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Provider Name | GABRIEL MARCOS MIZRAJI DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 550 DEEP VALLEY DR STE 345
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City | ROLLING HILLS ESTATES
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State | CA
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Zip | 90274-7603
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Country | US
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Telephone | 310-377-4551
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Fax |
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Provider Business Mailing Address
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Address Line | 5330 E EL PRADO AVE
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City | LONG BEACH
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State | CA
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Zip | 90815-3909
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Country | US
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Telephone | 562-498-7337
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 36264
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 36264
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License Number State | CA
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