Healthcare Provider Details

I. General information

NPI: 1386349736
Provider Name (Legal Business Name): GREGORY JAMES GOULDING CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 CENTER DR STE E
LA MESA CA
91942-2952
US

IV. Provider business mailing address

1576 FALDA DEL CERRO CT
EL CAJON CA
92019-3607
US

V. Phone/Fax

Practice location:
  • Phone: 619-466-6077
  • Fax: 619-466-6118
Mailing address:
  • Phone: 619-792-5847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number91638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: