Gordo, Mita R
Gordo, Mita R is an individual health care provider with primary practice located at 2505 W Hammer Ln , Stockton CA 95209-2839. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Gordo, Mita R can be contacted via phone (209) 957-7050.Contact Information
Primary practice address
2505 W Hammer Ln
Stockton CA 95209-2839
Phone: (209) 957-7050
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | A54477 | California |
Profile Details
| NPI number | 1619933553 |
|---|---|
| LBN Legal business name | Gordo, Mita R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 20th, 2006 |
| Last updated | Jun 21st, 2010 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619933553 | NPPES |
| California | MEDICAID | 00A544770 |
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