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NPI Code Detail

MEDICARE: EMILY GORTNER

MEDICARE: EMILY GORTNER
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
1171M00000XCase Manager/Care CoordinatorCA
2390200000XStudent in an Organized Health Care Education/Training ProgramCA
3106S00000XBehavior TechnicianRBT-19-108654CA

General Provider Information

NPI Number : 1659917532
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY GORTNER
Provider Business Mailing Address
First Line : 5639 AMAYA DR APT 293
Second Line :
City : LA MESA
State : CA
Zip : 91942-3695
Country : US
Telephone Number : 515-783-7638
Fax Number :
Provider Business Practice Location Address
First Line : 9245 ACTIVITY RD STE 106
Second Line :
City : SAN DIEGO
State : CA
Zip : 92126-4442
Country : US
Telephone Number : 858-428-0222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2019
Last Update Date : 12/15/2020

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