Provider Demographics
NPI:1811109523
Name:GORILIK, DENA K (LAC)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:K
Last Name:GORILIK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7511 LEXINGTON AVE
Mailing Address - Street 2:#10
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5527
Mailing Address - Country:US
Mailing Address - Phone:323-868-3257
Mailing Address - Fax:323-882-6587
Practice Address - Street 1:115 EAST WASHINGTON BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:GA
Practice Address - Zip Code:90015-3606
Practice Address - Country:US
Practice Address - Phone:213-741-0400
Practice Address - Fax:213-741-6373
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7109171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist