Healthcare Provider Details

I. General information

NPI: 1811964844
Provider Name (Legal Business Name): ARMANDO GONZALEZ SFIDC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MACG-38 MEDICAL
SAN DIEGO CA
92145
US

IV. Provider business mailing address

11375 POLARIS DR
SAN DIEGO CA
92126-1503
US

V. Phone/Fax

Practice location:
  • Phone: 858-577-9603
  • Fax: 858-577-8586
Mailing address:
  • Phone: 619-944-1872
  • Fax: 858-577-8586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: