MEDICARE: DR. ANNA MARIE B 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	207Q00000X	Family Medicine Physician	G65623	CA

General Provider Information

NPI Number	:	1770515132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA MARIE B GONZALEZ MD

Provider Business Mailing Address
First Line	:	3727 N FIRST ST.
Second Line	:	STE 106
City	:	FRESNO
State	:	CA
Zip	:	93726
Country	:	US
Telephone Number	:	559-457-6900
Fax Number	:	559-457-6990

Provider Business Practice Location Address
First Line	:	3727 N 1ST ST
Second Line	:	STE 106
City	:	FRESNO
State	:	CA
Zip	:	93726-5628
Country	:	US
Telephone Number	:	559-457-6900
Fax Number	:	559-457-6990

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	11/22/2011

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