Provider Demographics
NPI:1104936756
Name:RACHELEFSKY, GARY (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:RACHELEFSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:32-263 CHS
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3675
Mailing Address - Country:US
Mailing Address - Phone:310-206-3952
Mailing Address - Fax:310-206-0209
Practice Address - Street 1:200 UCLA MEDICAL PLAZA
Practice Address - Street 2:SUITE 140-17
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8344
Practice Address - Country:US
Practice Address - Phone:310-794-6884
Practice Address - Fax:310-261-5161
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG223392080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G223390Medicaid
CABX070YMedicare PIN
CA00G223390Medicaid
CAWG22339AMedicare PIN
CAWG22339EMedicare PIN