MEDICARE: JAN GOTERA

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1831553056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN GOTERA

Provider Business Mailing Address
First Line	:	433 BROSNAN CT
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-7217
Country	:	US
Telephone Number	:	415-860-7770
Fax Number	:

Provider Business Practice Location Address
First Line	:	433 BROSNAN CT
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-7217
Country	:	US
Telephone Number	:	415-860-7770
Fax Number	:

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

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	04/13/2016

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Directions to “ JAN GOTERA ” Practice Location

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