Provider Demographics
NPI:1154315851
Name:GONZALEZ, HUGO A (MD)
Entity Type:Individual
Prefix:DR
First Name:HUGO
Middle Name:A
Last Name:GONZALEZ
Suffix:
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 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8030
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:1300 W OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-5678
Practice Address - Country:US
Practice Address - Phone:805-737-1169
Practice Address - Fax:805-737-1772
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60620207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551905Medicare Oscar/Certification
CAW1508GMedicare PIN
CA00G606200Medicare ID - Type Unspecified
CA551983Medicare Oscar/Certification
CAE90065Medicare UPIN
CAW1508AMedicare PIN
CAW1508EMedicare PIN
CA551904Medicare Oscar/Certification
CA051847Medicare Oscar/Certification
CAW1508Medicare PIN