Healthcare Provider Details

I. General information

NPI: 1609817303
Provider Name (Legal Business Name): NONATO A LARGOZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIRCLE
TRAVIS AFB CA
94535
US

IV. Provider business mailing address

5141 FALATI LN
FAIRFIELD CA
94533-8977
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3731
  • Fax: 707-423-7419
Mailing address:
  • Phone: 707-437-5141
  • Fax: 707-437-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA70945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: