Individual
ALEXANDER GANTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
12053 EMELITA ST, #7, VALLEY VILLAGE, CA 91607
(323) 547-6760
Mailing address
12053 EMELITA ST, #7, VALLEY VILLAGE, CA 91607
(323) 547-6760
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PSY236950
—
CA
Enumeration date
06/16/2009
Last updated
08/01/2011
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