MEDICARE: DR. RAFAYEL GEVORKIAN M.D.

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	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	A41672	CA

General Provider Information

NPI Number	:	1982791562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAFAYEL GEVORKIAN M.D.

Provider Business Mailing Address
First Line	:	5129 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5715
Country	:	US
Telephone Number	:	323-663-9009
Fax Number	:	323-663-5550

Provider Business Practice Location Address
First Line	:	5129 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5715
Country	:	US
Telephone Number	:	323-663-9009
Fax Number	:	323-663-5550

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/09/2007

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