Provider Demographics
NPI:1639250335
Name:GANDHI, NEAL DINESH (OTR)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:DINESH
Last Name:GANDHI
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13123 CAROLYN ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8603
Mailing Address - Country:US
Mailing Address - Phone:562-221-6204
Mailing Address - Fax:562-921-8393
Practice Address - Street 1:13123 CAROLYN ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-8603
Practice Address - Country:US
Practice Address - Phone:562-221-6204
Practice Address - Fax:562-921-8393
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2833225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT2833Medicare PIN