Healthcare Provider Details

I. General information

NPI: 1417919929
Provider Name (Legal Business Name): IRMA YOLANDA GONZALEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 02/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 S SIERRA MADRE BLVD
PASADENA CA
91107-5240
US

IV. Provider business mailing address

504 S SIERRA MADRE BLVD
PASADENA CA
91107-5240
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-8811
  • Fax:
Mailing address:
  • Phone: 626-795-8811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG62810
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberG62810
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47184
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: