Healthcare Provider Details

I. General information

NPI: 1780662064
Provider Name (Legal Business Name): JAIME MARCOS GONZALES M.S., CGC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: MARCOS GONZALES M.S.,CGC

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6507 MISSION GORGE RD
SAN DIEGO CA
92120-2306
US

IV. Provider business mailing address

3697 CAMINITO CARMEL LNDG
SAN DIEGO CA
92130-2514
US

V. Phone/Fax

Practice location:
  • Phone: 619-528-6471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: