Healthcare Provider Details

I. General information

NPI: 1447360359
Provider Name (Legal Business Name): CALLE A GONZALES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CALLE ANN GONZALES-BAGDON

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S CLOVER DR
MOSES LAKE WA
98837-4417
US

IV. Provider business mailing address

1616 S PIONEER WAY
MOSES LAKE WA
98837-2487
US

V. Phone/Fax

Practice location:
  • Phone: 509-765-5606
  • Fax:
Mailing address:
  • Phone: 509-793-9715
  • Fax: 509-764-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMED-PHYS-LIC-103519
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16068
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD61092894
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD61092894
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD61092894
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD11372
License Number StateHI
# 7
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG-71741
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number16068
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: