Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT 32843 | CA |
NPI | 1053334664 |
---|---|
Provider Name | Mr. Dharmesh Ishwar Gordhan |
First Address | Ventura, CA 93001-3326 |
Second Address | Ventura, CA 93003-5662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 07/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT 32843 | PT BOARD LICENSE (01) | CA |