Provider Demographics
NPI:1164438073
Name:GONZALEZ, ANGEL G (MD)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:G
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 1:1945 N FINE STREET
Mailing Address - Street 2:116
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727
Mailing Address - Country:US
Mailing Address - Phone:559-457-5807
Mailing Address - Fax:559-457-5896
Practice Address - Street 1:5784 S ELM AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:CA
Practice Address - Zip Code:93706
Practice Address - Country:US
Practice Address - Phone:559-457-5600
Practice Address - Fax:559-457-5690
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A80580OtherLICENSE #
BG8116522OtherDEA
A80580OtherLICENSE #