MEDICARE: DINO JUDE GONZALEZ MD LTD

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
1	207R00000X	Internal Medicine Physician	9912	NV

General Provider Information

NPI Number	:	1194913145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DINO JUDE GONZALEZ MD LTD

Provider Business Mailing Address
First Line	:	705 JACOBS LADDER PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-7540
Country	:	US
Telephone Number	:	702-808-5759
Fax Number	:	702-877-5946

Provider Business Practice Location Address
First Line	:	2300 W CHARLESTON BLVD
Second Line	:	SUITE 265
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2149
Country	:	US
Telephone Number	:	702-877-8629
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DINO JUDE GONZALEZ
Credential	:	M.D.
Telephone Number	:	702-808-5759

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	03/07/2023

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