MEDICARE: JOSE ANGEL GONZALEZ MD

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	207N00000X	Dermatology Physician	A176718	CA
2	207ND0101X	MOHS-Micrographic Surgery Physician	A176718	CA

General Provider Information

NPI Number	:	1437646288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE ANGEL GONZALEZ MD

Provider Business Mailing Address
First Line	:	1207 CARLSBAD VILLAGE DR STE Q
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1958
Country	:	US
Telephone Number	:	760-669-3375
Fax Number	:	630-625-9829

Provider Business Practice Location Address
First Line	:	1207 CARLSBAD VILLAGE DR STE Q
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1958
Country	:	US
Telephone Number	:	760-669-3375
Fax Number	:	630-625-9829

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

Provider Enumeration Date	:	04/17/2018
Last Update Date	:	06/17/2026

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