Provider Demographics
NPI:1669815858
Name:GILSTRAP, MELVIN GEORGE
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:GEORGE
Last Name:GILSTRAP
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 1:600 E 7TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90021-1439
Mailing Address - Country:US
Mailing Address - Phone:213-537-0110
Mailing Address - Fax:
Practice Address - Street 1:600 E. 7TH ST. #105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90021-1439
Practice Address - Country:US
Practice Address - Phone:213-537-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)