Provider Demographics
NPI:1134260268
Name:GANDIN, JEFFREY STUART (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STUART
Last Name:GANDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N BEDFORD DR
Mailing Address - Street 2:STE. 307
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4324
Mailing Address - Country:US
Mailing Address - Phone:310-497-8900
Mailing Address - Fax:310-551-4131
Practice Address - Street 1:450 N BEDFORD DR
Practice Address - Street 2:STE. 307
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4324
Practice Address - Country:US
Practice Address - Phone:310-497-8900
Practice Address - Fax:310-551-4131
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0648082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry