Provider Demographics
NPI:1477639755
Name:JANI, GILDA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:GILDA
Middle Name:
Last Name:JANI
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 1:218 W MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7709
Mailing Address - Country:US
Mailing Address - Phone:714-665-8824
Mailing Address - Fax:714-665-8829
Practice Address - Street 1:218 W MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7709
Practice Address - Country:US
Practice Address - Phone:714-665-8824
Practice Address - Fax:714-665-8829
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 6571171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist