Healthcare Provider Details

I. General information

NPI: 1578656336
Provider Name (Legal Business Name): STEVEN ROBERT GATES B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16111 PLUMMER ST
SEPULVEDA CA
91343
US

IV. Provider business mailing address

43602 16TH ST EAST
LANCASTER CA
93535-4346
US

V. Phone/Fax

Practice location:
  • Phone: 818-891-7711
  • Fax:
Mailing address:
  • Phone: 818-891-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: