1528493491 NPI number — MICHAELA E. GORDON, OTR/L, INC.

Table of content: DR. RONALD ROBERT EVENSON DDS (NPI 1093715112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528493491 NPI number — MICHAELA E. GORDON, OTR/L, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAELA E. GORDON, OTR/L, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528493491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2713 ANTONIO DR
Provider Second Line Business Mailing Address:
UNIT 301
Provider Business Mailing Address City Name:
CAMARILLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93010-1449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-290-0933
Provider Business Mailing Address Fax Number:
805-233-7249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2713 ANTONIO DRIVE
Provider Second Line Business Practice Location Address:
UNIT 301
Provider Business Practice Location Address City Name:
CAMARILLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-290-0933
Provider Business Practice Location Address Fax Number:
805-233-7249
Provider Enumeration Date:
09/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
MICHAELA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
805-290-0933

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  8753 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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