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Organization
FOOTHILLS BLVD CLINIC LLC
Active
Organization
FOOTHILLS BLVD CLINIC LLC
Active
Other names
Foothills Blvd Clinic, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STAMATIA FISSAS GOCKEL DO (OWNER/PHYSICIAN)
(928) 342-1814
Entity
Organization
Contact information
Practice address
11611 S FOOTHILLS BLVD, SUITE C, YUMA, AZ 85367
(928) 342-1814
(928) 342-6154
Mailing address
11611 S FOOTHILLS BLVD, SUITE C, YUMA, AZ 85367
(928) 342-1814
(928) 342-6154
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
02/26/2007
Last updated
02/03/2012
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