Provider Demographics
NPI:1336226489
Name:YUZEF GUROVICH M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:YUZEF GUROVICH M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YUZEF
Authorized Official - Middle Name:
Authorized Official - Last Name:GUROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-956-0500
Mailing Address - Street 1:815 E. COLORADO ST
Mailing Address - Street 2:# 220
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1298
Mailing Address - Country:US
Mailing Address - Phone:818-956-0500
Mailing Address - Fax:818-956-8489
Practice Address - Street 1:815 E COLORADO ST
Practice Address - Street 2:# 220
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1200
Practice Address - Country:US
Practice Address - Phone:818-956-0500
Practice Address - Fax:818-956-8489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41072207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50449Medicare UPIN
CAA41072AMedicare ID - Type Unspecified