Provider Demographics
NPI:1376557991
Name:GONZALEZ, MARIO HUMBERTO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:HUMBERTO
Last Name:GONZALEZ
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:7131 N 11TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3375
Mailing Address - Country:US
Mailing Address - Phone:559-435-0717
Mailing Address - Fax:559-435-9105
Practice Address - Street 1:7131 N 11TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3375
Practice Address - Country:US
Practice Address - Phone:559-435-0717
Practice Address - Fax:559-435-9105
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-10-26
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Provider Licenses
StateLicense IDTaxonomies
CA00A414620208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88563Medicare UPIN
CA00A414621Medicare PIN