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General NPI Number Information
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NPI Number | 1568756971
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Entity Type | Organization
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Legal Business Name | GITA K.MEDICAL CORP.
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 26671 ALISO CREEK RD SUITE 205
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City | ALISO VIEJO
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State | CA
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Zip | 92656-4809
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Country | US
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Telephone | 949-864-6667
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Fax |
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Provider Business Mailing Address
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Address Line | 4 CRYSTALGLEN
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City | ALISO VIEJO
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State | CA
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Zip | 92656-1909
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Country | US
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Telephone | 714-595-0545
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Fax |
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Authorized Official
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Title or Position | FAMILY MEDICINE DOCTOR
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Name | GITA JAMSHIDI KALANTARI
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Credential | M.D.
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Telephone | 949-362-0208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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