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General NPI Number Information
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NPI Number | 1902109721
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Entity Type | Individual
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Provider Name | GLADYS MITANI PHARM. D.
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Gender | Female
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Dates
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Enumeration Date | 12/16/2010
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Last Update Date | 12/16/2010
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Provider Practice Location Address
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Address Line | 1100 N STATE ST CLINIC TOWERS A4A
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City | LOS ANGELES
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State | CA
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Zip | 90033-5000
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Country | US
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Telephone | 323-409-7575
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Fax | 323-441-8145
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Provider Business Mailing Address
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Address Line | 1985 ZONAL AVE SUITE 604
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City | LOS ANGELES
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State | CA
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Zip | 90089-9121
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Country | US
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Telephone | 323-409-7575
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Fax | 323-441-8145
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 27861
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License Number State | CA
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