Basic Information
| Provider Information | |||||||||
| NPI: | 1720099823 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONSALVES | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16955 VIA DEL CAMPO | ||||||||
| Address2: | STE 215 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921277720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586736100 | ||||||||
| FaxNumber: | 8586736113 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 E VALLEY PKWY | ||||||||
| Address2: | PALOMAR MEDICAL CTR | ||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607393000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 06/30/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A78816 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.