Provider Demographics
NPI:1417919929
Name:GONZALEZ, IRMA YOLANDA (MD)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:YOLANDA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 S SIERRA MADRE BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-5240
Mailing Address - Country:US
Mailing Address - Phone:626-795-8811
Mailing Address - Fax:
Practice Address - Street 1:504 S SIERRA MADRE BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-5240
Practice Address - Country:US
Practice Address - Phone:626-795-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62810208000000X, 2080P0204X
CO47184208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F11479Medicare UPIN