Provider Demographics
NPI:1821118282
Name:GOSTICH, CYRIL METHODIAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:CYRIL
Middle Name:METHODIAS
Last Name:GOSTICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 E DANENBERG DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-8511
Mailing Address - Country:US
Mailing Address - Phone:760-352-2257
Mailing Address - Fax:760-352-4579
Practice Address - Street 1:852 E DANENBERG DR
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-8511
Practice Address - Country:US
Practice Address - Phone:760-352-2257
Practice Address - Fax:760-352-4579
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3744213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGRE001481Medicaid
CAU05634Medicare UPIN
CAGRE001481Medicaid
CAW16770Medicare PIN