=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396879466
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEVEN M. GITLIN M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 12/28/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2010 WILSHIRE BLVD SUITE 506
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90057-3507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-413-5444
-----------------------------------------------------
Fax | 213-413-3577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9735 WILSHIRE BLVD SUITE #339
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90212-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-276-5298
-----------------------------------------------------
Fax | 310-276-5299
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. STEVEN MARK GITLIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 310-276-5298
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | G28726
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------