1922191717 NPI number — ERLINDA MARIA GORDON MD

Table of content: ERLINDA MARIA GORDON MD (NPI 1922191717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922191717 NPI number — ERLINDA MARIA GORDON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORDON
Provider First Name:
ERLINDA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922191717
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6430 W SUNSET BLVD
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90028-7901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-669-2337
Provider Business Mailing Address Fax Number:
323-644-8488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2811 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE # 414
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90403-4803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-669-2121
Provider Business Practice Location Address Fax Number:
323-660-7128
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0207X , with the licence number:  A48717 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A487170 G15 . This is a "CAL OPTIMA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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