Provider Demographics
NPI:1558354332
Name:GONZALEZ, GUSTAVO ALEJANDRO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:ALEJANDRO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93942-0211
Mailing Address - Country:US
Mailing Address - Phone:831-724-8000
Mailing Address - Fax:831-724-3724
Practice Address - Street 1:900 CASS ST
Practice Address - Street 2:STE 103
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4544
Practice Address - Country:US
Practice Address - Phone:831-373-1291
Practice Address - Fax:831-373-0313
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2007-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG78302207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G783021Medicaid
CA00G783020Medicare ID - Type Unspecified
CA00G783021Medicaid