=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265606636
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLINICA DEL SOL MEDICAL GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2008
-----------------------------------------------------
Last Update Date | 04/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41120 WASHINGTON ST SUITE 103
-----------------------------------------------------
City | BERMUDA DUNES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92203-9215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-772-3348
-----------------------------------------------------
Fax | 760-772-8414
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41120 WASHINGTON ST SUITE 103
-----------------------------------------------------
City | BERMUDA DUNES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92203-9215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-772-3348
-----------------------------------------------------
Fax | 760-772-8414
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESDENT
-----------------------------------------------------
Name | DR. HUGO ARNULFO GONZALEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 760-772-3348
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | G60620
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------