Healthcare Provider Details

I. General information

NPI: 1720064454
Provider Name (Legal Business Name): ANGELICA GONZALEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 RIVERSIDE ST
NASHUA NH
03062-1373
US

IV. Provider business mailing address

2300 SOUTHWOOD DR
NASHUA NH
03063-1899
US

V. Phone/Fax

Practice location:
  • Phone: 603-595-3614
  • Fax:
Mailing address:
  • Phone: 603-695-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number11311
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11311
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: