Healthcare Provider Details

I. General information

NPI: 1265958862
Provider Name (Legal Business Name): RICARDO GONZALEZ MD FAMILY PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 SIERRA HIGHLANDS DR STE 101
RENO NV
89523-2301
US

IV. Provider business mailing address

2005 SIERRA HIGHLANDS DR STE 101
RENO NV
89523-2301
US

V. Phone/Fax

Practice location:
  • Phone: 775-624-6492
  • Fax:
Mailing address:
  • Phone: 775-624-6492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10279
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number10279
License Number StateNV

VIII. Authorized Official

Name: DR. RICARDO J. GONZALEZ
Title or Position: OWNER
Credential: MD
Phone: 775-624-6492