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NPI Code Detail

MEDICARE: GARY GOCKMAN

MEDICARE:   GARY  GOCKMAN
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
1363A00000XPhysician AssistantCA

General Provider Information

NPI Number : 1619548039
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY GOCKMAN
Provider Business Mailing Address
First Line : 829 MALTMAN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-2711
Country : US
Telephone Number : 630-730-3193
Fax Number :
Provider Business Practice Location Address
First Line : 8218 GARFIELD AVE
Second Line :
City : BELL GARDENS
State : CA
Zip : 90201-6212
Country : US
Telephone Number : 818-836-7316
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2021
Last Update Date : 07/07/2021

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Directions to “ GARY GOCKMAN ” Practice Location

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