Individual
GOMGOM SIREGAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5235 S LIVERPOOL WAY, CENTENNIAL, CO 80015
(720) 998-6372
Mailing address
5235 S LIVERPOOL WAY, CENTENNIAL, CO 80015
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87637065
—
CO
Enumeration date
04/18/2016
Last updated
04/18/2016
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