Provider Demographics
NPI:1356339253
Name:GONZALEZ, MILAGROS (MD)
Entity type:Individual
Prefix:DR
First Name:MILAGROS
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 1:9220 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2416
Mailing Address - Country:US
Mailing Address - Phone:602-997-9898
Mailing Address - Fax:602-997-9901
Practice Address - Street 1:9220 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2416
Practice Address - Country:US
Practice Address - Phone:602-997-9898
Practice Address - Fax:602-997-9901
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26882208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ831512OtherAHCCCS