MEDICARE: DR. CHRISTIAN ISRAEL GARAYCOCHEA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	A90223	CA
2	207L00000X	Anesthesiology Physician	A90223	CA
3	207L00000X	Anesthesiology Physician	13797	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A902230	OTHER	CA	BLUE SHIELD OF CALIFORNIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104942887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIAN ISRAEL GARAYCOCHEA MD

Provider Business Mailing Address
First Line	:	3153 E WARM SPRINGS RD #300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120
Country	:	US
Telephone Number	:	702-487-6510
Fax Number	:	702-405-7960

Provider Business Practice Location Address
First Line	:	322 KAREN AVE
Second Line	:	UNIT 1207
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-0412
Country	:	US
Telephone Number	:	801-368-0468
Fax Number	:	801-880-3841

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	02/05/2015

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