Healthcare Provider Details

I. General information

NPI: 1306588868
Provider Name (Legal Business Name): LOURDES GONZALEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 W THUNDERBIRD RD STE W202
GLENDALE AZ
85306-5612
US

IV. Provider business mailing address

5757 W THUNDERBIRD RD STE W202
GLENDALE AZ
85306-5612
US

V. Phone/Fax

Practice location:
  • Phone: 602-678-1111
  • Fax:
Mailing address:
  • Phone: 602-678-1111
  • Fax: 833-973-5936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number66773
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: