Healthcare Provider Details

I. General information

NPI: 1356339253
Provider Name (Legal Business Name): MILAGROS GONZALEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 N CENTRAL AVE
PHOENIX AZ
85020-2416
US

IV. Provider business mailing address

9220 N CENTRAL AVE
PHOENIX AZ
85020-2416
US

V. Phone/Fax

Practice location:
  • Phone: 602-997-9898
  • Fax: 602-997-9901
Mailing address:
  • Phone: 602-997-9898
  • Fax: 602-997-9901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26882
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: