Healthcare Provider Details

I. General information

NPI: 1235001314
Provider Name (Legal Business Name): SERGIO DAVID GONZALES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2376 GLENMONT CIR APT T6 T6
SILVER SPRING MD
20902-1351
US

IV. Provider business mailing address

2376 GLENMONT CIR APT T6
SILVER SPRING MD
20902-1351
US

V. Phone/Fax

Practice location:
  • Phone: 771-217-3602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA00197942
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: