Healthcare Provider Details

I. General information

NPI: 1336337294
Provider Name (Legal Business Name): BALTIMORE JOSHUA GONZALEZ IV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S CEDAR AVE
FRESNO CA
93702-2908
US

IV. Provider business mailing address

205 N BLACKSTONE AVE
FRESNO CA
93701-1914
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-6084
  • Fax: 559-600-6084
Mailing address:
  • Phone: 559-498-0241
  • Fax: 559-498-6220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: