Healthcare Provider Details

I. General information

NPI: 1376730119
Provider Name (Legal Business Name): JOSE GOCHOCO DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 STOCKTON HILL RD #102
KINGMAN AZ
86401-4698
US

IV. Provider business mailing address

PO BOX 4450
KINGMAN AZ
86402-4450
US

V. Phone/Fax

Practice location:
  • Phone: 928-279-3109
  • Fax: 928-222-0227
Mailing address:
  • Phone: 928-718-4375
  • Fax: 928-222-0227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE L GOCHOCO
Title or Position: MANAGING MEMBER
Credential: D.O.
Phone: 928-718-4375