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General NPI Number Information
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NPI Number | 1184899874
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Entity Type | Individual
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Provider Name | KELLY DE GONZALES M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 9400 N NAME UNO
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City | GILROY
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State | CA
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Zip | 95020-3528
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Country | US
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Telephone | 408-852-4830
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Fax |
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Provider Business Mailing Address
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Address Line | 18550 DE PAUL DR STE 203
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City | MORGAN HILL
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State | CA
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Zip | 95037-2911
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Country | US
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Telephone | 408-852-4830
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | AH19180185639
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 258365
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A109752
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License Number State | CA
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