Provider Demographics
NPI:1740202506
Name:GONZALEZ, SUSANA G (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSANA
Middle Name:G
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 1:1100 TRANCAS ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2908
Mailing Address - Country:US
Mailing Address - Phone:707-251-1850
Mailing Address - Fax:707-226-1502
Practice Address - Street 1:1100 TRANCAS ST
Practice Address - Street 2:SUITE 209
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2908
Practice Address - Country:US
Practice Address - Phone:707-251-1850
Practice Address - Fax:707-226-1502
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75475207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0081500Medicaid
CAGR0081501OtherMEDICAL
CAGR0081501OtherMEDI_CAL
CADK415ZMedicare PIN
G09570Medicare UPIN