Healthcare Provider Details

I. General information

NPI: 1205898558
Provider Name (Legal Business Name): GERARDO WILLIAM HIZON MD, FAAFP, CAQSM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27699 JEFFERSON AVE STE 101
TEMECULA CA
92590-2696
US

IV. Provider business mailing address

27699 JEFFERSON AVE STE 101
TEMECULA CA
92590-2696
US

V. Phone/Fax

Practice location:
  • Phone: 951-790-0107
  • Fax: 951-667-1933
Mailing address:
  • Phone: 951-790-0107
  • Fax: 951-667-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberG55359
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG55359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: