MEDICARE: DR. MILAGROS GONZALEZ 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
1	208000000X	Pediatrics Physician	26882	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	831512	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1356339253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MILAGROS GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	9220 N CENTRAL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2416
Country	:	US
Telephone Number	:	602-997-9898
Fax Number	:	602-997-9901

Provider Business Practice Location Address
First Line	:	9220 N CENTRAL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2416
Country	:	US
Telephone Number	:	602-997-9898
Fax Number	:	602-997-9901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	08/02/2011

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