Provider Demographics
NPI:1679939714
Name:GANDIA, SHERWIN (COTA)
Entity type:Individual
Prefix:
First Name:SHERWIN
Middle Name:
Last Name:GANDIA
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12882 SHACKELFORD LN
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-5109
Mailing Address - Country:US
Mailing Address - Phone:714-638-9470
Mailing Address - Fax:
Practice Address - Street 1:12882 SHACKELFORD LN
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-5109
Practice Address - Country:US
Practice Address - Phone:714-638-9470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3386225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation