MEDICARE: GILBERT GONZALES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	G70533	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144261462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GILBERT GONZALES

Provider Business Mailing Address
First Line	:	18200 YORBA LINDA BLVD
Second Line	:	SUITE 401
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-4056
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18200 YORBA LINDA BLVD
Second Line	:	SUITE 108
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-4056
Country	:	US
Telephone Number	:	714-524-6977
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	12/01/2021

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Directions to “ GILBERT GONZALES ” Practice Location

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