Provider Demographics
NPI:1013180355
Name:GISLASON, IRVING LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:LEE
Last Name:GISLASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7404 E. SADDLEHILL TRL
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-2310
Mailing Address - Country:US
Mailing Address - Phone:714-971-7652
Mailing Address - Fax:714-971-8927
Practice Address - Street 1:12443 LEWIS ST. STE. 103
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4650
Practice Address - Country:US
Practice Address - Phone:714-971-7652
Practice Address - Fax:714-971-8927
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA240102084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology