Healthcare Provider Details

I. General information

NPI: 1215763057
Provider Name (Legal Business Name): MYA LYNN GATES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E VIRGINIA ST
SAN JOSE CA
95112-5857
US

IV. Provider business mailing address

160 E VIRGINIA ST STE 280
SAN JOSE CA
95112-5817
US

V. Phone/Fax

Practice location:
  • Phone: 408-938-2113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: