Healthcare Provider Details

I. General information

NPI: 1659313534
Provider Name (Legal Business Name): ANDREA TERAN GONZALES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N 10TH ST
SANTA PAULA CA
93060-1309
US

IV. Provider business mailing address

1216 VELMA MILES PL
EL PASO TX
79912-7484
US

V. Phone/Fax

Practice location:
  • Phone: 805-525-7171
  • Fax: 805-505-2955
Mailing address:
  • Phone: 915-833-6920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA91755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: