Provider Demographics
NPI:1063510063
Name:GONZALEZ, OLGA LYDIA (MD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:LYDIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-5870
Mailing Address - Country:US
Mailing Address - Phone:530-751-8454
Mailing Address - Fax:530-751-8456
Practice Address - Street 1:1231 PLUMAS ST
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3410
Practice Address - Country:US
Practice Address - Phone:530-751-8454
Practice Address - Fax:530-751-8456
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG077811208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics