Provider Demographics
NPI:1992028591
Name:GALINA MAKOVOZ MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GALINA MAKOVOZ MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROYTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-650-5494
Mailing Address - Street 1:7607 SANTA MONICA BLVD STE 27
Mailing Address - Street 2:
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 STE 27
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47756261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A477561Medicaid
CA00A477560Medicaid
CAA47756AMedicare PIN
CA00A477561Medicaid
CA00A477560Medicaid