Provider Demographics
NPI:1902830060
Name:GONZALEZ, AIMEE (MD)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
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 1:125 S 5TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2408
Mailing Address - Country:US
Mailing Address - Phone:760-344-8100
Mailing Address - Fax:760-545-0243
Practice Address - Street 1:529 PINE AVE
Practice Address - Street 2:
Practice Address - City:HOLTVILLE
Practice Address - State:CA
Practice Address - Zip Code:92250-1121
Practice Address - Country:US
Practice Address - Phone:760-756-3112
Practice Address - Fax:760-545-0257
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51815207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG40602Medicare UPIN
CAW13536A-HMedicare PIN
CAGR663010Medicare PIN