Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G55359 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | G55359 | CA |
NPI | 1205898558 |
---|---|
Provider Name | Gerardo William Hizon |
First Address | Temecula, CA 92590-2696 |
Second Address | Temecula, CA 92590-2696 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 24/06/2019 |