Healthcare Provider Details

I. General information

NPI: 1326431016
Provider Name (Legal Business Name): ANGELA LOIS GONZALES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2576 HAMNER AVE SUITE B
NORCO CA
92860-1922
US

IV. Provider business mailing address

2576 HAMNER AVE SUITE B
NORCO CA
92860-1922
US

V. Phone/Fax

Practice location:
  • Phone: 951-582-0262
  • Fax: 877-700-5045
Mailing address:
  • Phone: 951-582-0262
  • Fax: 877-700-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG070532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: