MEDICARE: AYLMER GOZUM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95006214	CA

General Provider Information

NPI Number	:	1619418381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYLMER GOZUM

Provider Business Mailing Address
First Line	:	6556 CERRITOS AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-2448
Country	:	US
Telephone Number	:	213-248-5216
Fax Number	:

Provider Business Practice Location Address
First Line	:	6556 CERRITOS AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-2448
Country	:	US
Telephone Number	:	213-248-5216
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2017
Last Update Date	:	03/03/2026

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Directions to “ AYLMER GOZUM ” Practice Location

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