Healthcare Provider Details

I. General information

NPI: 1295042232
Provider Name (Legal Business Name): MICHAEL GITTER M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 WILSHIRE BLVD
LOS ANGELES CA
90057-3503
US

IV. Provider business mailing address

2011 WILSHIRE BLVD
LOS ANGELES CA
90057-3503
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-2700
  • Fax: 213-484-1367
Mailing address:
  • Phone: 213-413-2700
  • Fax: 213-484-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG20658
License Number StateCA

VIII. Authorized Official

Name: EVA TORRES
Title or Position: ADMINISTRATIVE SECRETARY
Credential:
Phone: 213-413-2700