Gavin Ulric Anderson

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

R1568440724 Issued in CA

Practice address

2521 Long Beach Ave
Los Angeles, CA 90058-1324

Phone

(760) 905-8063

NPI assigned

Dec 4, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1245046291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "786 MIRAFLORES",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907311460",
            "telephone_number": "760-905-8063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2521 LONG BEACH AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900581324",
            "telephone_number": "760-905-8063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "GAVIN",
        "middle_name": "ULRIC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-12-04",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1568440724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elmer Alfred Anderson Jr., M.D.
• Elna Anderson, RN
• Elvin Anderson
• Erik Anderson, LMFT
• Erika B Anderson
• Glenna Patrice Anderson, LCSW
• Houshang Farokhi Anderson
• Jabriel Anderson
• Jacob Raymond Anderson, DO
• Jaiden Anderson

• Addiction (Substance Use Disorder) Counselor in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.