Provider Demographics
NPI:1659313534
Name:GONZALES, ANDREA TERAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:TERAN
Last Name:GONZALES
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 1:1216 VELMA MILES PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7484
Mailing Address - Country:US
Mailing Address - Phone:915-833-6920
Mailing Address - Fax:
Practice Address - Street 1:825 N 10TH ST
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-1309
Practice Address - Country:US
Practice Address - Phone:805-525-7171
Practice Address - Fax:805-505-2955
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91755207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A917550Medicaid
CA1659313534Medicaid
CAWA91755BMedicare PIN
CA1659313534Medicaid
CA00A917550Medicaid