Provider Demographics
NPI:1114416781
Name:NAHAMIA, GILDA SARA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:GILDA
Middle Name:SARA
Last Name:NAHAMIA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-2508
Mailing Address - Country:US
Mailing Address - Phone:310-270-3602
Mailing Address - Fax:
Practice Address - Street 1:1349 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2603
Practice Address - Country:US
Practice Address - Phone:310-270-3602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17336171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist