NPI 1043664907

Gomgom Siregar

Practitioner Home Health Aide Centennial, CO

Practice location

Address: 5235 S Liverpool Way, Centennial, CO 80015
Phone: (720) 998-6372

Registered specialties

Home Health Aide Primary

Nursing Service Related Providers Taxonomy 374U00000X

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Registry record

NPI: 1043664907
Entity type: Individual
Sex (as registered): Male
NPI issued: 18 Apr 2016
Record last updated: 18 Apr 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.