Healthcare Provider Details

I. General information

NPI: 1104762509
Provider Name (Legal Business Name): MICHAEL GOZAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 W CENTRAL AVE STE 200
BREA CA
92821-3066
US

IV. Provider business mailing address

380 W CENTRAL AVE STE 200
BREA CA
92821-3066
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-0811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT25861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: