Healthcare Provider Details

I. General information

NPI: 1023024932
Provider Name (Legal Business Name): SALVADOR GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/07/2023
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S ORANGE AVE
FRESNO CA
93702
US

IV. Provider business mailing address

1945 N FINE STREET 116
FRESNO CA
93727
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-5400
  • Fax: 559-457-5490
Mailing address:
  • Phone: 559-457-5807
  • Fax: 559-457-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA60322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: