Healthcare Provider Details

I. General information

NPI: 1437646288
Provider Name (Legal Business Name): JOSE ANGEL GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 CARLSBAD VILLAGE DR STE Q
CARLSBAD CA
92008-1958
US

IV. Provider business mailing address

1207 CARLSBAD VILLAGE DR STE Q
CARLSBAD CA
92008-1958
US

V. Phone/Fax

Practice location:
  • Phone: 760-669-3375
  • Fax: 630-625-9829
Mailing address:
  • Phone: 760-669-3375
  • Fax: 630-625-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA176718
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA176718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: