Search › California › 224Z00000X
Andrew Gultom, COTA
NPI 1518159409 · on the registry since 2007 · sole proprietor
Practice
- Address
- 1065 Driftwood Cir
Banning, CA 92220 - Phone
- (909) 856-6625
- Fax
- (877) 799-9128
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
- 2007-08-14
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