MEDICARE: MR. PETER ANTHONY GONZALEZ

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	101YM0800X	Mental Health Counselor
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1427181924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER ANTHONY GONZALEZ

Provider Business Mailing Address
First Line	:	3433 W SHAW AVE STE 108
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3229
Country	:	US
Telephone Number	:	559-558-4051
Fax Number	:	559-550-0348

Provider Business Practice Location Address
First Line	:	3433 W SHAW AVE STE 107
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3229
Country	:	US
Telephone Number	:	559-749-2115
Fax Number	:	559-550-0348

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	01/08/2024

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