Provider Demographics
NPI:1942448543
Name:GOSSCHALK, EDDY (CPO)
Entity Type:Individual
Prefix:MR
First Name:EDDY
Middle Name:
Last Name:GOSSCHALK
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 CARDINAL CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3333
Mailing Address - Country:US
Mailing Address - Phone:858-292-7449
Mailing Address - Fax:858-292-5496
Practice Address - Street 1:8875 LA MESA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5134
Practice Address - Country:US
Practice Address - Phone:619-589-9980
Practice Address - Fax:619-589-9988
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist