Provider Demographics
NPI:1346343225
Name:GONZALES, FERNANDO Q (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:Q
Last Name:GONZALES
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 1:12444 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1005
Mailing Address - Country:US
Mailing Address - Phone:562-698-0161
Mailing Address - Fax:562-698-8740
Practice Address - Street 1:12444 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1005
Practice Address - Country:US
Practice Address - Phone:562-698-0161
Practice Address - Fax:562-698-8740
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA382252085R0202X
CAC38225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology