Provider Demographics
NPI:1205720273
Name:GONZALES, ROBERT JOHN
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOHN
Last Name:GONZALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 LYNDELL TER STE 104
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-6205
Mailing Address - Country:US
Mailing Address - Phone:530-808-5318
Mailing Address - Fax:
Practice Address - Street 1:2050 LYNDELL TER STE 104
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6205
Practice Address - Country:US
Practice Address - Phone:530-808-5318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL10013207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty