Healthcare Provider Details

I. General information

NPI: 1073601852
Provider Name (Legal Business Name): JOSE IGNACIO GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 N CORONADO DR STE A
SIERRA VISTA AZ
85635-6360
US

IV. Provider business mailing address

PO BOX 64447
TUCSON AZ
85728
US

V. Phone/Fax

Practice location:
  • Phone: 520-458-1208
  • Fax: 520-458-1675
Mailing address:
  • Phone: 520-458-1208
  • Fax: 520-458-1675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number21227
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number21227
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: