Provider Demographics
NPI:1013037993
Name:GONZALEZ-HOWARD, MARY A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:A
Last Name:GONZALEZ-HOWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4770 W HERNDON AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-8401
Mailing Address - Country:US
Mailing Address - Phone:559-256-7990
Mailing Address - Fax:559-256-7991
Practice Address - Street 1:4770 W HERNDON AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-8401
Practice Address - Country:US
Practice Address - Phone:559-256-7990
Practice Address - Fax:559-256-7991
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068349A208000000X
CAA94656208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400029281Medicare PIN
IN200985070Medicaid