MEDICARE: ANDREY GOKHGAUZER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	28298	CA
2	235Z00000X	Speech-Language Pathologist	13306	CA
3	225X00000X	Occupational Therapist	4089	CA

General Provider Information

NPI Number	:	1043083488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREY GOKHGAUZER

Provider Business Mailing Address
First Line	:	21051 WARNER CENTER LN STE 100
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-6566
Country	:	US
Telephone Number	:	424-335-5505
Fax Number	:

Provider Business Practice Location Address
First Line	:	21051 WARNER CENTER LN STE 100
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-6566
Country	:	US
Telephone Number	:	424-335-5505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	11/06/2023

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