Organization
GERALD T GOSTANIAN MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD GOSTANIAN MD (PHYSICIAN)
(949) 640-4650
Entity
Organization
Contact information
Practice address
400 NEWPORT CENTER DR STE 202A, NEWPORT BEACH, CA 92660-7680
(949) 640-4650
Mailing address
400 NEWPORT CENTER DR STE 202A, NEWPORT BEACH, CA 92660-7680
(949) 640-4650
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
A22986
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A22986
STATE LICENSE
CA
Enumeration date
12/22/2011
Last updated
12/22/2011
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