Gushansky, Larissa
Gushansky, Larissa is an sole proprietor health care provider with primary practice located at 3175 Firestone Blvd # 200 , South Gate CA 90280-2951. She recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Dentist. Dental Providers / Dentist is her primary health care specialty. Gushansky, Larissa can be contacted via phone (323) 563-9124.Contact Information
Primary practice address
3175 Firestone Blvd # 200
South Gate CA 90280-2951
Phone: (323) 563-9124
Fax: (323) 563-9814
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 36156 | California |
| Dental Providers / Dentist | 122300000X | 36156 | California |
Profile Details
| NPI number | 1548478399 |
|---|---|
| LBN Legal business name | Gushansky, Larissa |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 17th, 2007 |
| Last updated | Nov 30th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548478399 | NPPES |
| California | MEDICAID | B36156-01 | |
| California | MEDICAID | B36156-02 |
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