Individual
DR. COREY GERALD GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4067 LADERA VISTA RD, FALLBROOK, CA 92028-9433
(757) 513-5594
Mailing address
4067 LADERA VISTA RD, FALLBROOK, CA 92028-9433
(757) 513-5594
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0102201624
VA
207P00000X
Emergency Medicine Physician
Primary
20A13551
CA
Other
Enumeration date
12/14/2005
Last updated
09/18/2015
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