Provider Demographics
NPI:1922188200
Name:GONZAGA, EDUARDO JUAN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:JUAN
Last Name:GONZAGA
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:111H C/O THE JERRY L PETTIS VAMC
Mailing Address - Street 2:11201 BENTON STREET
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92357-0001
Mailing Address - Country:US
Mailing Address - Phone:909-583-6176
Mailing Address - Fax:
Practice Address - Street 1:111H C/O THE JERRY L PETTIS VAMC
Practice Address - Street 2:11201 BENTON STREET
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357-0001
Practice Address - Country:US
Practice Address - Phone:909-583-6176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-053203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine