Healthcare Provider Details

I. General information

NPI: 1649109653
Provider Name (Legal Business Name): STAMGOCO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14372 E WARREN DR
YUMA AZ
85367-7589
US

IV. Provider business mailing address

14372 E WARREN DR
YUMA AZ
85367-7589
US

V. Phone/Fax

Practice location:
  • Phone: 928-580-6810
  • Fax: 928-248-4660
Mailing address:
  • Phone: 928-580-6810
  • Fax: 928-248-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STAMATIA FISSAS GOCKEL
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 928-580-6810