Provider Demographics
NPI:1770515132
Name:GONZALEZ, ANNA MARIE B (MD)
Entity type:Individual
Prefix:DR
First Name:ANNA MARIE
Middle Name:B
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 N FIRST ST.
Mailing Address - Street 2:STE 106
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726
Mailing Address - Country:US
Mailing Address - Phone:559-457-6900
Mailing Address - Fax:559-457-6990
Practice Address - Street 1:3727 N 1ST ST
Practice Address - Street 2:STE 106
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-5628
Practice Address - Country:US
Practice Address - Phone:559-457-6900
Practice Address - Fax:559-457-6990
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE25172Medicare UPIN