Provider Demographics
NPI:1720592587
Name:NERI, GERHOMAR CAMPANTERO (COTA/L)
Entity Type:Individual
Prefix:
First Name:GERHOMAR
Middle Name:CAMPANTERO
Last Name:NERI
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9107 SELMA ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-6140
Mailing Address - Country:US
Mailing Address - Phone:818-436-9928
Mailing Address - Fax:
Practice Address - Street 1:6212 TUDOR WAY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-7067
Practice Address - Country:US
Practice Address - Phone:818-436-9928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA3863224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant