Healthcare Provider Details

I. General information

NPI: 1447207402
Provider Name (Legal Business Name): JOHN MICHAEL GONZALES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100-C ALBRIGHT WAY
SAN JOSE CA
95032-1837
US

IV. Provider business mailing address

100-C ALBRIGHT WAY
SAN JOSE CA
95032-1837
US

V. Phone/Fax

Practice location:
  • Phone: 408-866-5227
  • Fax: 408-866-5228
Mailing address:
  • Phone: 408-866-5227
  • Fax: 408-866-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberG56012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: