Healthcare Provider Details

I. General information

NPI: 1053334664
Provider Name (Legal Business Name): DHARMESH ISHWAR GORDHAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/24/2023
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 STATHAM BLVD
OXNARD CA
93033-3901
US

IV. Provider business mailing address

2051 STATHAM BLVD
OXNARD CA
93033-3901
US

V. Phone/Fax

Practice location:
  • Phone: 805-293-6213
  • Fax:
Mailing address:
  • Phone: 805-293-6213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 32843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: