Individual
MR. SERGIO R GONZALEZ MANSILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
HAD
Contact information
Practice address
4720 E STATE BLVD, FORT WAYNE, IN 46815-6923
(260) 471-5693
(260) 471-4942
Mailing address
1841 N ELMER ST, SOUTH BEND, IN 46628-3203
(574) 367-2700
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
17001630A
IN
Other
Enumeration date
04/08/2025
Last updated
03/18/2026
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