Healthcare Provider Details

I. General information

NPI: 1770515132
Provider Name (Legal Business Name): ANNA MARIE B GONZALEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 N 1ST ST STE 106
FRESNO CA
93726-5628
US

IV. Provider business mailing address

3727 N FIRST ST. STE 106
FRESNO CA
93726
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-6900
  • Fax: 559-457-6990
Mailing address:
  • Phone: 559-457-6900
  • Fax: 559-457-6990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG65623
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: