Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 1799 | TN |
N | 111NI0900X | Internist | 1799 | TN |
Y | 207RX0202X | Medical Oncology | 10801 | CA |
NPI | 1114937844 |
---|---|
Provider Name | Alexander Gaitanis |
First Address | Hermosa Beach, CA 90254-2245 |
Second Address | Beverly Hills, CA 90211-1958 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 05/04/2017 |