Provider Demographics
NPI:1093052201
Name:GAOIRAN, JEROME
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:GAOIRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 W 3RD ST
Mailing Address - Street 2:APT 1-238
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1616
Mailing Address - Country:US
Mailing Address - Phone:510-449-6740
Mailing Address - Fax:
Practice Address - Street 1:3311 W 3RD ST
Practice Address - Street 2:APT 1-238
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1616
Practice Address - Country:US
Practice Address - Phone:510-449-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist