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NPI Code Detail

MEDICARE: TIMOTY MARK GONZALEZ M.D.

MEDICARE: TIMOTY MARK 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
1207R00000XInternal Medicine PhysicianA63479CA

General Provider Information

NPI Number : 1982647319
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTY MARK GONZALEZ M.D.
Provider Business Mailing Address
First Line : PO BOX 35380
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-5380
Country : US
Telephone Number : 702-579-3203
Fax Number :
Provider Business Practice Location Address
First Line : 2750 E SLAUSON AVE
Second Line :
City : HUNTINGTON PARK
State : CA
Zip : 90255-3063
Country : US
Telephone Number : 323-582-1863
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 12/16/2025

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