Provider Demographics
NPI:1437265089
Name:GITLIN, JAMES G (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:GITLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:GREGORIO
Other - Last Name:GITLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:17822 BEACH BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647
Mailing Address - Country:US
Mailing Address - Phone:714-848-0258
Mailing Address - Fax:714-843-0398
Practice Address - Street 1:17822 BEACH BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647
Practice Address - Country:US
Practice Address - Phone:714-848-0258
Practice Address - Fax:714-843-0398
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25576207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A255760Medicaid
CA00A255760Medicaid
CAA25576Medicare ID - Type Unspecified