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General NPI Number Information
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NPI Number | 1609155084
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Entity Type | Organization
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Legal Business Name | IRINA GANELIS, M.D., P.C.
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Dates
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Enumeration Date | 08/16/2011
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Last Update Date | 06/01/2012
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Provider Practice Location Address
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Address Line | 16661 VENTURA BLVD SUITE 523
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City | ENCINO
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State | CA
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Zip | 91436-1914
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Country | US
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Telephone | 818-394-0003
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Fax | 206-350-1012
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Provider Business Mailing Address
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Address Line | 9663 SANTA MONICA BLVD # 396
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4303
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Country | US
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Telephone | 310-773-3396
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IRINA BYKHOVSKAYA GANELIS
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Credential | M.D.
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Telephone | 310-773-3396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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