Provider Demographics
NPI:1558351833
Name:MAKOVOZ, GALINA (MD)
Entity Type:Individual
Prefix:MRS
First Name:GALINA
Middle Name:
Last Name:MAKOVOZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7607 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 27
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6400
Mailing Address - Country:US
Mailing Address - Phone:323-650-5494
Mailing Address - Fax:323-650-5495
Practice Address - Street 1:7607 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 27
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6400
Practice Address - Country:US
Practice Address - Phone:323-650-5494
Practice Address - Fax:323-650-5495
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47756208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A477661Medicaid
CA00A475560Medicaid
CA00A477661Medicaid
CAA47756Medicare ID - Type Unspecified
CAA47765AMedicare ID - Type Unspecified