Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003208042 |
---|---|
Provider Name | Moises Gomez |
First Address | Pasadena, CA 91105-2048 |
Second Address | Pasadena, CA 91105-2048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2015 |
Last Update Date | 27/02/2015 |