Individual
SAMUEL GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
34101 FARENHOLT AVE, SAN DIEGO, CA 92134-7000
(915) 330-7612
Mailing address
11415 OAK CREEK DR, LAKESIDE, CA 92040-1236
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
09/18/2023
Last updated
09/18/2023
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