Individual
MR. BRIAN GONZALES PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
426 N IMPERIAL AVE, EL CENTRO, CA 92243-2329
(760) 592-8148
(760) 841-5556
Mailing address
3760 CONVOY ST STE 101, SAN DIEGO, CA 92111-3743
(858) 264-1434
(858) 751-0901
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
34600
CA
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
07/19/2018
Last updated
01/09/2020
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