Individual
MR. OSCAR R GONGORA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3231 BUENA VISTA AVE, SUITE # A, LEMON GROVE, CA 91945-2413
(619) 698-1455
(619) 460-1743
Mailing address
PO BOX 1339, LEMON GROVE, CA 91946-1339
(619) 698-1455
(619) 460-1743
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
N3655341
CA
Other
Enumeration date
07/13/2007
Last updated
07/13/2007
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