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NPI Code Detail

MEDICARE: MRS. AURORA GONZAGA M.D.

MEDICARE: MRS. AURORA GONZAGA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist35032393OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154314334
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AURORA GONZAGA M.D.
Provider Business Mailing Address
First Line : PO BOX 367
Second Line :
City : MOGADORE
State : OH
Zip : 44260-0367
Country : US
Telephone Number : 330-628-1325
Fax Number :
Provider Business Practice Location Address
First Line : 195 WADSWORTH RD
Second Line :
City : WADSWORTH
State : OH
Zip : 44281-9504
Country : US
Telephone Number : 330-334-2863
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2005
Last Update Date : 07/08/2007

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