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General NPI Number Information
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NPI Number | 1972212892
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Entity Type | Individual
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Provider Name | JARED MICHAEL GORTER
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Gender | Male
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Dates
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Enumeration Date | 11/18/2022
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 1240 S WESTLAKE BLVD STE 205
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-1992
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Country | US
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Telephone | 805-495-0551
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Fax |
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Provider Business Mailing Address
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Address Line | 14056 VALLEYHEART DR APT 316
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-5410
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Country | US
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Telephone | 559-908-9212
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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