Provider Demographics
NPI:1508860016
Name:GONZALEZ, DAVID REGAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:REGAN
Last Name: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 1:26732 CROWN VALLEY PKWY STE 151
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6337
Mailing Address - Country:US
Mailing Address - Phone:949-347-6044
Mailing Address - Fax:949-347-1606
Practice Address - Street 1:26732 CROWN VALLEY PKWY STE 151
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6337
Practice Address - Country:US
Practice Address - Phone:949-347-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG078684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG16247Medicare UPIN