Healthcare Provider Details

I. General information

NPI: 1790032571
Provider Name (Legal Business Name): GARY PETER-JAMES VAN LUE GONZALEZ D.C., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E DEVONSHIRE AVE
HEMET CA
92543-3083
US

IV. Provider business mailing address

1117 E DEVONSHIRE AVE
HEMET CA
92543-3083
US

V. Phone/Fax

Practice location:
  • Phone: 951-791-1111
  • Fax:
Mailing address:
  • Phone: 951-652-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA203406
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC32385
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA203406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: