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General NPI Number Information
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NPI Number | 1396094207
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Entity Type | Organization
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Legal Business Name | LOS ANGELES DIABETES ASSOCIATES, INC.
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 1701 E CESAR E CHAVEZ AVE STE 306
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City | LOS ANGELES
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State | CA
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Zip | 90033-2475
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Country | US
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Telephone | 626-252-5559
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 86326
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City | LOS ANGELES
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State | CA
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Zip | 90086-0326
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Country | US
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Telephone | 626-252-5559
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Fax |
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Authorized Official
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Title or Position | OWNER / PHYSICIAN
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Name | CHRISTIAN GASTELUM
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Credential | M.D.
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Telephone | 626-252-5559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | A74589
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License Number State | CA
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