MEDICARE: GENTIAN LLURI

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	207R00000X	Internal Medicine Physician	114499	CA
2	207RC0000X	Cardiovascular Disease Physician	CA114499	CA
3	207RI0011X	Interventional Cardiology Physician	114499	CA

General Provider Information

NPI Number	:	1154595346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENTIAN LLURI

Provider Business Mailing Address
First Line	:	221 W NATOMA AVE
Second Line	:
City	:	ADDISON
State	:	IL
Zip	:	60101-3505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 MEDICAL PLAZA DRIVEWAY SUITE 630
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-7232
Country	:	US
Telephone Number	:	310-794-9629
Fax Number	:

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

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	11/26/2018

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Directions to “ GENTIAN LLURI ” Practice Location

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