Provider Demographics
NPI:1316407364
Name:BRITO GONZALEZ, ARIEL (MD)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:BRITO 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 1:1305 BEAR MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:ARVIN
Mailing Address - State:CA
Mailing Address - Zip Code:93203-1231
Mailing Address - Country:US
Mailing Address - Phone:618-543-1316
Mailing Address - Fax:661-854-2689
Practice Address - Street 1:1305 BEAR MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:ARVIN
Practice Address - State:CA
Practice Address - Zip Code:93203-1231
Practice Address - Country:US
Practice Address - Phone:618-543-1316
Practice Address - Fax:661-854-2689
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTL71390200000X
CAA178301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program