Provider Demographics
NPI:1316064181
Name:GORNAY, EDMUND
Entity type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:
Last Name:GORNAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11326 MOUNTAIN VIEW AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3817
Mailing Address - Country:US
Mailing Address - Phone:909-799-9944
Mailing Address - Fax:909-799-1828
Practice Address - Street 1:11326 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3817
Practice Address - Country:US
Practice Address - Phone:909-799-9944
Practice Address - Fax:909-799-1828
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA226382251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT226380Medicare ID - Type UnspecifiedMEDICARE