Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 22638 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | 22638 | CA |
NPI | 1316064181 |
---|---|
Provider Name | Mr. Edmund Gornay |
First Address | Loma Linda, CA 92354-3817 |
Second Address | Loma Linda, CA 92354-3817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2007 |
Last Update Date | 20/10/2014 |