Search › California › 224Z00000X
Edwin Gultom, COTA
NPI 1316256084 · on the registry since 2010
Practice
- Address
- 16890 Green Tree Blvd
Victorville, CA 92395 - Phone
- (760) 245-5361
- Organisation at this address
- Knolls West Enterprises
Knolls West Post Acute Llc
Knolls West Assisted Living, Llc.Inferred from a shared address, not stated in the registry.
Registry record
- Primary taxonomy
- 224Z00000X
224Z00000X
- Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2010-09-29
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California