Healthcare Provider Details

I. General information

NPI: 1639195365
Provider Name (Legal Business Name): JOSE L GOCHOCO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 N STOCKTON HILL RD SUITE 102
KINGMAN AZ
86401-4698
US

IV. Provider business mailing address

3285 N JEWEL ST
KINGMAN AZ
86401-3818
US

V. Phone/Fax

Practice location:
  • Phone: 928-718-4375
  • Fax: 928-222-0227
Mailing address:
  • Phone: 928-293-0227
  • Fax: 928-692-2746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number1715
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1715
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: