Provider Demographics
NPI:1891758892
Name:GONZALES, CHARLOTTE VERONICA (MD)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:VERONICA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:CHARLOTTE
Other - Middle Name:VERONICA
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1186 BRITTAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3929
Mailing Address - Country:US
Mailing Address - Phone:650-591-2675
Mailing Address - Fax:650-591-7452
Practice Address - Street 1:1186 BRITTAN AVE
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3929
Practice Address - Country:US
Practice Address - Phone:650-591-2675
Practice Address - Fax:650-591-7452
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86661207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI06648Medicare UPIN
CA00A866610Medicare ID - Type Unspecified