Healthcare Provider Details

I. General information

NPI: 1679619076
Provider Name (Legal Business Name): FRANK D. GONZALES, MD APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E COOK ST SUITE C
SANTA MARIA CA
93454-5141
US

IV. Provider business mailing address

301 E COOK ST SUITE C
SANTA MARIA CA
93454-5141
US

V. Phone/Fax

Practice location:
  • Phone: 805-345-3030
  • Fax: 805-345-3033
Mailing address:
  • Phone: 805-345-3030
  • Fax: 805-345-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG48455
License Number StateCA

VIII. Authorized Official

Name: DR. FRANK DENNIS GONZALES
Title or Position: PRESIDENT, MEDICAL DIRECTOR
Credential: MD, MPH
Phone: 805-345-3030