MEDICARE: DR. EDUARDO JOSE GONZALEZ M.D.

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	207Q00000X	Family Medicine Physician	A73502	CA

General Provider Information

NPI Number	:	1992731798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDUARDO JOSE GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	3625 MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE 7
City	:	LYNWOOD
State	:	CA
Zip	:	90262-3509
Country	:	US
Telephone Number	:	310-763-1336
Fax Number	:	310-763-1350

Provider Business Practice Location Address
First Line	:	3625 MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE 7
City	:	LYNWOOD
State	:	CA
Zip	:	90262-3509
Country	:	US
Telephone Number	:	310-763-1336
Fax Number	:	310-763-1350

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	07/08/2007

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