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General NPI Number Information
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NPI Number | 1568400455
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Entity Type | Organization
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Legal Business Name | GATEWAY MEDICAL GROUP OF SAN DIEGO
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 08/19/2009
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Provider Practice Location Address
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Address Line | 752 MEDICAL CENTER CT SUITE 210
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City | CHULA VISTA
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State | CA
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Zip | 91911-6658
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Country | US
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Telephone | 619-527-7700
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Fax | 619-527-3226
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Provider Business Mailing Address
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Address Line | 286 EUCLID AVE SUITE 207
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City | SAN DIEGO
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State | CA
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Zip | 92114-3610
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Country | US
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Telephone | 619-527-7700
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Fax | 619-527-3226
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD D SANZONE
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Credential | DO
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Telephone | 619-527-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | W13278
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License Number State | CA
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