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General NPI Number Information
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NPI Number | 1962145029
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Entity Type | Organization
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Legal Business Name | GNOSIS GERIATRIC WELLCARE CENTER INC
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Dates
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Enumeration Date | 04/18/2022
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Last Update Date | 04/16/2023
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Provider Practice Location Address
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Address Line | 12555 GARDEN GROVE BLVD STE 304
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1903
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Country | US
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Telephone | 714-353-5333
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Fax |
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Provider Business Mailing Address
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Address Line | 2617 E CHAPMAN AVE
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City | ORANGE
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State | CA
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Zip | 92869-3226
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. GERARDO CANCHOLA
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Credential | MD
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Telephone | 714-353-5333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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