Provider Demographics
NPI:1780608471
Name:GONZALEZ, JULIO CEASAR (MD)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:CEASAR
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 HARTLAND RD
Mailing Address - Street 2:# 207
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-3500
Mailing Address - Country:US
Mailing Address - Phone:703-573-1282
Mailing Address - Fax:703-573-1284
Practice Address - Street 1:2841 HARTLAND RD
Practice Address - Street 2:# 207
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-3500
Practice Address - Country:US
Practice Address - Phone:703-573-1282
Practice Address - Fax:703-573-1284
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101034712174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC88535Medicare UPIN
VA198192Medicare PIN