Provider Demographics
NPI:1326011297
Name:GONZALEZ, RICARDO JUAN (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:JUAN
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 SIERRA HIGHLANDS DR
Mailing Address - Street 2:STE 101
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2301
Mailing Address - Country:US
Mailing Address - Phone:775-624-6000
Mailing Address - Fax:775-624-6010
Practice Address - Street 1:2005 SIERRA HIGHLANDS DR
Practice Address - Street 2:STE 101
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-2301
Practice Address - Country:US
Practice Address - Phone:775-624-6000
Practice Address - Fax:775-624-6010
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00963848OtherMEDICARE RR
NVBE9184OtherMEDICARE PTAN