# FOOTHILLS BLVD CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Foothills Blvd Clinic, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801922356
- **Authorized official:** DR. STAMATIA FISSAS GOCKEL DO (OWNER/PHYSICIAN)
- **Authorized official phone:** (928) 342-1814

## Contact information

- **Practice address:** 11611 S FOOTHILLS BLVD, SUITE C, YUMA, AZ 85367
- **Practice address phone:** (928) 342-1814
- **Practice address fax:** (928) 342-6154
- **Mailing address:** 11611 S FOOTHILLS BLVD, SUITE C, YUMA, AZ 85367
- **Mailing address phone:** (928) 342-1814
- **Mailing address fax:** (928) 342-6154

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/26/2007
- **Last updated:** 02/03/2012