Healthcare Provider Details

I. General information

NPI: 1366891608
Provider Name (Legal Business Name): EUGEN STEPHAN GOESER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 07/11/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE 3RD FLOOR, ROOM 3438
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

200 MERCY CIRCLE 3RD FLOOR, ROOM 3438
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-4774
  • Fax:
Mailing address:
  • Phone: 760-719-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1743
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: