# GERALD T GOSTANIAN MD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093084881
- **Authorized official:** DR. GERALD GOSTANIAN MD (PHYSICIAN)
- **Authorized official phone:** (949) 640-4650

## Contact information

- **Practice address:** 400 NEWPORT CENTER DR STE 202A, NEWPORT BEACH, CA 92660-7680
- **Practice address phone:** (949) 640-4650
- **Mailing address:** 400 NEWPORT CENTER DR STE 202A, NEWPORT BEACH, CA 92660-7680
- **Mailing address phone:** (949) 640-4650

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | A22986 | CA | Yes |

## Other

- **Enumeration date:** 12/22/2011
- **Last updated:** 12/22/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | A22986 | STATE LICENSE | CA |