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NPI Code Detail

MEDICARE: DR. GRAHAM GITLIN M.D.

MEDICARE: DR. GRAHAM GITLIN 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
1174400000XSpecialistA63525CA

General Provider Information

NPI Number : 1982688990
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GRAHAM GITLIN M.D.
Provider Business Mailing Address
First Line : 2201 MARINE ST
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-6041
Country : US
Telephone Number : 310-785-6614
Fax Number : 310-785-6631
Provider Business Practice Location Address
First Line : 2080 CENTURY PARK E STE 809
Second Line :
City : LOS ANGELES
State : CA
Zip : 90067-2011
Country : US
Telephone Number : 310-785-6614
Fax Number : 310-785-6631
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2005
Last Update Date : 01/29/2020

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