Healthcare Provider Details

I. General information

NPI: 1427181924
Provider Name (Legal Business Name): MR. PETER ANTHONY GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 W SHAW AVE STE 107
FRESNO CA
93711-3229
US

IV. Provider business mailing address

3433 W SHAW AVE STE 107
FRESNO CA
93711-3229
US

V. Phone/Fax

Practice location:
  • Phone: 559-749-2115
  • Fax: 559-550-0348
Mailing address:
  • Phone: 559-476-2115
  • Fax: 559-550-0348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: