Healthcare Provider Details

I. General information

NPI: 1639269913
Provider Name (Legal Business Name): RENE GONZALEZ GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2006
Last Update Date: 03/02/2023
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 HWAY 95 STE 23
BULLHEAD CITY AZ
86442-6744
US

IV. Provider business mailing address

PO BOX 90182
HENDERSON NV
89009-0182
US

V. Phone/Fax

Practice location:
  • Phone: 928-234-3834
  • Fax: 602-792-7270
Mailing address:
  • Phone: 928-293-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number587
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301117103
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15953
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301117103
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: