Healthcare Provider Details

I. General information

NPI: 1891720074
Provider Name (Legal Business Name): PATRICIA D GONZALES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N 6TH AVE
HOPEWELL VA
23860-2618
US

IV. Provider business mailing address

PO BOX 11768
RICHMOND VA
23230-0168
US

V. Phone/Fax

Practice location:
  • Phone: 804-458-1430
  • Fax: 804-458-8857
Mailing address:
  • Phone: 804-545-6870
  • Fax: 804-213-9783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101026123
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: