Provider Demographics
NPI:1902824493
Name:GILTNAN, ALEXANDER SMITH (LAC)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:SMITH
Last Name:GILTNAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5964
Mailing Address - Country:US
Mailing Address - Phone:714-957-6889
Mailing Address - Fax:714-546-8616
Practice Address - Street 1:1182 BRISTOL ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5964
Practice Address - Country:US
Practice Address - Phone:714-957-6889
Practice Address - Fax:714-546-8616
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12715171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC12715OtherSTATE LICENSE NUMBER