Provider Demographics
NPI:1043238801
Name:GONZALEZ, FAUSTINO M II (MD)
Entity Type:Individual
Prefix:
First Name:FAUSTINO
Middle Name:M
Last Name:GONZALEZ
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 N TENAYA WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0456
Mailing Address - Country:US
Mailing Address - Phone:480-981-0216
Mailing Address - Fax:480-981-1151
Practice Address - Street 1:4331 E BASELINE RD
Practice Address - Street 2:STE B106-625
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2961
Practice Address - Country:US
Practice Address - Phone:480-834-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23659207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4288971Medicaid
AZP00402206OtherRAILROAD MEDICARE
AZ115284Medicare PIN
G21495Medicare UPIN
AZZ115284Medicare PIN
AZ4288971Medicaid