Provider Demographics
NPI:1609026434
Name:GORDON, EDWARD FRANCIS (LAC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:FRANCIS
Last Name:GORDON
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Gender:M
Credentials:LAC
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Mailing Address - Street 1:12304 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2551
Mailing Address - Country:US
Mailing Address - Phone:310-254-4117
Mailing Address - Fax:310-828-3532
Practice Address - Street 1:2812 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2476
Practice Address - Country:US
Practice Address - Phone:310-254-4117
Practice Address - Fax:310-828-3532
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2016-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA9333171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist