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GERALD KELTON BACKUS
>> Case Manager/Care Coordinator >> Other Service ProvidersRegistrant NPI Number: 1114464732
Individual Registrant: GERALD KELTON BACKUS
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
6800 OWENSMOUTH AVE CANOGA PARK, CA 91303-3159 US
Tel: 818-610-6726 Fax: --
Tel: 818-610-6726 Fax: --
Contact information for business:
6800 OWENSMOUTH AVE CANOGA PARK, CA 91303-3159 US
Tel: -- Fax: --
Tel: -- Fax: --
Registration Information:
NPI: 1114464732
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 171M00000X | Other Service Providers Case Manager/Care Coordinator |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
