1568756971 NPI number — GITA K.MEDICAL CORP.

Table of content: (NPI 1568756971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568756971 NPI number — GITA K.MEDICAL CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GITA K.MEDICAL CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1568756971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 CRYSTALGLEN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALISO VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92656-1909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-595-0545
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26671 ALISO CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
ALISO VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92656-4809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-864-6667
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KALANTARI
Authorized Official First Name:
GITA
Authorized Official Middle Name:
JAMSHIDI
Authorized Official Title or Position:
FAMILY MEDICINE DOCTOR
Authorized Official Telephone Number:
949-362-0208

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A958470 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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