MEDICARE: DR. DAVID A. GILDER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	G42480	CA

General Provider Information

NPI Number	:	1669579678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A. GILDER M.D.

Provider Business Mailing Address
First Line	:	54433 FILE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5405 MOREHOUSE DR
Second Line	:	SUITE#100
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-4722
Country	:	US
Telephone Number	:	858-554-6394
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	09/23/2011

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