Healthcare Provider Details

I. General information

NPI: 1427764372
Provider Name (Legal Business Name): JUANA LUCIO GONZALEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 N SANBORN RD
SALINAS CA
93905-2218
US

IV. Provider business mailing address

55 PLAZA CIR
SALINAS CA
93901-2952
US

V. Phone/Fax

Practice location:
  • Phone: 831-757-3721
  • Fax: 831-757-8284
Mailing address:
  • Phone: 831-757-8689
  • Fax: 831-757-3721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP13
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: