Healthcare Provider Details

I. General information

NPI: 1982637849
Provider Name (Legal Business Name): OMAR Y GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9060 E VIA LINDA STE 250
SCOTTSDALE AZ
85258-5425
US

IV. Provider business mailing address

9060 E VIA LINDA STE 250
SCOTTSDALE AZ
85258-5425
US

V. Phone/Fax

Practice location:
  • Phone: 480-614-2000
  • Fax: 480-614-1751
Mailing address:
  • Phone: 480-614-2000
  • Fax: 480-614-1751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number31845
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: