Healthcare Provider Details

I. General information

NPI: 1578036133
Provider Name (Legal Business Name): DR. GENEVIEVE GOTTARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 11/03/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOLLOMAN MEDICAL GROUP 280 DAVID L. GOLDFEIN STREET, BLDG 23, HOLLOMAN AFB
APO AA
88330
US

IV. Provider business mailing address

HOLLOMAN MEDICAL GROUP 280 DAVID L. GOLDFEIN STREET, BLDG 23, HOLLOMAN AFB
APO AA
88330
US

V. Phone/Fax

Practice location:
  • Phone: 575-572-5676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: