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General NPI Number Information
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NPI Number | 1326337833
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Entity Type | Organization
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Legal Business Name | MARIO H GONZALEZ MD INC
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 11/29/2011
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Provider Practice Location Address
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Address Line | 7131 N 11TH ST SUITE 101
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City | FRESNO
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State | CA
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Zip | 93720-3375
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Country | US
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Telephone | 559-435-0717
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Fax | 559-435-9105
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Provider Business Mailing Address
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Address Line | 7131 N 11TH ST SUITE 101
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City | FRESNO
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State | CA
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Zip | 93720-3375
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Country | US
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Telephone | 559-435-0717
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Fax | 559-435-9105
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIO H GONZALEZ
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Credential | M.D.
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Telephone | 559-435-0717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A41462
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License Number State | CA
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