Brian Gonzales Puckett

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

426 N Imperial Ave
El Centro, CA 92243-2329

Phone

(760) 592-8148

Fax

(760) 841-5556

NPI assigned

Jul 19, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578528000000",
    "number": "1912484205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3760 CONVOY ST STE 101",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921113743",
            "telephone_number": "858-264-1434",
            "fax_number": "858-751-0901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "426 N IMPERIAL AVE",
            "city": "EL CENTRO",
            "state": "CA",
            "postal_code": "922432329",
            "telephone_number": "760-592-8148",
            "fax_number": "760-841-5556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "BRIAN",
        "middle_name": "GONZALES",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-19",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "34600",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in El Centro, CA
• Providers in El Centro, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.