Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 16675 | PR |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | MD 440572 | PA |
Y | 2081S0010X | Sports Medicine | ME109856 | FL |
Y | 213ES0000X | Sports Medicine | ME109856 | FL |
NPI | 1407050404 |
---|---|
Provider Name | Dr. Luis A Gandara |
First Address | Lake Mary, FL 32746-4871 |
Second Address | Lake Mary, FL 32746-4871 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 04/11/2020 |