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1083492391
SAMUEL GONZALEZ
SAN DIEGO, CA
NPI
1083492391
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1710I1002X Military Health Care Provider, Independent Duty Corpsman
Enumeration Date
2023-09-18
Last Update Date
2023-09-18
Business Address
SAMUEL GONZALEZ IDC
34101 FARENHOLT AVE
SAN DIEGO, CA 92134-7000
Phone number: 915-330-7612
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Mailing Address
SAMUEL GONZALEZ IDC
11415 OAK CREEK DR
LAKESIDE, CA 92040-1236
Phone number:
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