Physician Compare National (NPI:1619080041)

HEALTHCARE PROVIDER: GUSTAVO ARTURO MONDRAGON M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1619080041
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6406740463
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070510000417
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MONDRAGON
	Individual professional last name
Provider First Name	GUSTAVO
	Individual professional first name
Provider Middle Name	ARTURO
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1971
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	480 4TH AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 500
	Group Practice or individual's line 2 address
City	CHULA VISTA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	919104414
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050222
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SHARP CHULA VISTA MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050077
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SCRIPPS MERCY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y