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General NPI Number Information
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NPI Number | 1649414400
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Entity Type | Individual
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Provider Name | IRINA B GANELIS MD
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Gender | Female
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Dates
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Enumeration Date | 04/23/2009
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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 |
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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 |
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A99531
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License Number State | CA
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