Healthcare Provider Details

I. General information

NPI: 1740511260
Provider Name (Legal Business Name): FRANK GONZALEZ V
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NMCB 4 25284
FPO AP
96601-4941
US

IV. Provider business mailing address

301 W VINEYARD AVE APT 465
OXNARD CA
93036-2078
US

V. Phone/Fax

Practice location:
  • Phone: 760-509-6003
  • Fax:
Mailing address:
  • Phone: 760-509-6003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: