Provider Demographics
NPI:1184708570
Name:LATA, GILIAN NEIDITCH (LAC, DIPL OM)
Entity type:Individual
Prefix:MRS
First Name:GILIAN
Middle Name:NEIDITCH
Last Name:LATA
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:12500 RIVERSIDE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3441
Mailing Address - Country:US
Mailing Address - Phone:818-763-2928
Mailing Address - Fax:818-763-2928
Practice Address - Street 1:12500 RIVERSIDE DR STE 202
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3441
Practice Address - Country:US
Practice Address - Phone:818-763-2928
Practice Address - Fax:818-763-2928
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11249171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist