Provider Demographics
NPI:1033261144
Name:GONZALEZ, MARTHA (MD, MPH)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N. BRENT STREET
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2854
Mailing Address - Country:US
Mailing Address - Phone:805-656-4311
Mailing Address - Fax:805-643-5020
Practice Address - Street 1:116 N. BRENT STREET
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2854
Practice Address - Country:US
Practice Address - Phone:805-656-4311
Practice Address - Fax:805-643-5020
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68703207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG68703Medicare ID - Type Unspecified
F18568Medicare UPIN
CAF18568Medicare UPIN