Individual
JEFFREY ANDREW VAN GORDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6425 CANTERWOOD RD, LA VERNE, CA 91750-1211
(909) 267-4342
Mailing address
6425 CANTERWOOD RD, LA VERNE, CA 91750-1211
(909) 267-4342
Taxonomy
Speciality
Code
Description
License number
State
177F00000X
Lodging Provider
Primary
—
—
Other
Enumeration date
12/20/2024
Last updated
12/20/2024
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