Provider Demographics
NPI:1093084535
Name:GARY R SCHLECTER MD INC
Entity Type:Organization
Organization Name:GARY R SCHLECTER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHLECTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-560-1885
Mailing Address - Street 1:4900 OVERLAND AVE UNIT 322
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4292
Mailing Address - Country:US
Mailing Address - Phone:310-560-1885
Mailing Address - Fax:
Practice Address - Street 1:4900 OVERLAND AVE UNIT 322
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4292
Practice Address - Country:US
Practice Address - Phone:310-560-1885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG319090103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG31909Medicare PIN
CAFR059AMedicare PIN