MEDICARE: DR. GABRIEL MARCOS MIZRAJI DDS, MS

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	1223P0221X	Pediatric Dentistry	36264	CA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	36264	CA

General Provider Information

NPI Number	:	1528105277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIEL MARCOS MIZRAJI DDS, MS

Provider Business Mailing Address
First Line	:	5330 E EL PRADO AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-3909
Country	:	US
Telephone Number	:	562-498-7337
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 DEEP VALLEY DR STE 345
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-7603
Country	:	US
Telephone Number	:	310-377-4551
Fax Number	:

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	12/08/2010

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