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General NPI Number Information
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NPI Number | 1073006375
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Entity Type | Individual
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Provider Name | GRZEGORZ SEBASTIAN PUCHALA DO
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Gender | Male
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 7300 N FRESNO ST
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City | FRESNO
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State | CA
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Zip | 93720-2941
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Country | US
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Telephone | 559-448-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 6036 LAUGHING CREEK ST
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City | LAS VEGAS
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State | NV
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Zip | 89148-5518
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Country | US
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Telephone | 702-466-5630
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | TL6832
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 14038A
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | S9053
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20A23057
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | S9053
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License Number State | TX
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