Healthcare Provider Details

I. General information

NPI: 1306226915
Provider Name (Legal Business Name): RUBY GONZALEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W FOOTHILL BLVD
GLENDORA CA
91741-3361
US

IV. Provider business mailing address

440 W FOOTHILL BLVD
GLENDORA CA
91741-3361
US

V. Phone/Fax

Practice location:
  • Phone: 626-963-9402
  • Fax:
Mailing address:
  • Phone: 626-963-9402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA149561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: