| Gerardo Canchola Md, Inc. | |
|
2621 S Bristol St Ste 308 Santa Ana CA 92704-5719 | |
| (714) 662-7710 | |
| (714) 662-4407 |
| Full Name | Gerardo Canchola Md, Inc. |
|---|---|
| Speciality | General Practice |
| Location | 2621 S Bristol St Ste 308, Santa Ana, California |
| Authorized Official Name and Position | Gerardo Canchola (OWNER) |
| Authorized Official Contact | 7146627710 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gerardo Canchola Md, Inc. 2621 S Bristol St Ste 308 Santa Ana CA 92704-5719 Ph: (714) 662-7710 | Gerardo Canchola Md, Inc. 2621 S Bristol St Ste 308 Santa Ana CA 92704-5719 Ph: (714) 662-7710 |
| NPI Number | 1487191516 |
|---|---|
| Provider Enumeration Date | 01/26/2017 |
| Last Update Date | 11/15/2022 |
| Medicare PECOS PAC ID | 8123380938 |
|---|---|
| Medicare Enrollment ID | O20180314001971 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487191516 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | G55328 (California) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Gerardo Canchola |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639185879 PECOS PAC ID: 0547210643 Enrollment ID: I20100628000844 |
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