Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | LEP3210 | CA |
N | 103T00000X | Psychologist | LEP3210 | CA |
Y | 103TS0200X | School Psychologist | LEP3210 | CA |
NPI | 1063541811 |
---|---|
Provider Name | Dr. Jonathan Brian Gage |
First Address | Bakersfield, CA 93314-8032 |
Second Address | Bakersfield, CA 93314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 02/08/2018 |