Provider Demographics
NPI:1851497911
Name:GONZALEZ, CASIMIRO (MD)
Entity Type:Individual
Prefix:
First Name:CASIMIRO
Middle Name:
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 1:4566 FLORENCE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-4345
Mailing Address - Country:US
Mailing Address - Phone:323-562-0055
Mailing Address - Fax:
Practice Address - Street 1:4566 FLORENCE AVE
Practice Address - Street 2:#3
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-4345
Practice Address - Country:US
Practice Address - Phone:323-562-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66511207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA66511OtherLICENSE NUMBER
CA00A665111Medicaid
CAW17295Medicare ID - Type Unspecified
CAA66511OtherLICENSE NUMBER