Provider Demographics
NPI:1447729272
Name:GONZALES MEDICAL CORPORATION
Entity type:Organization
Organization Name:GONZALES MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY EPPIE
Authorized Official - Middle Name:PORCIUNCULA
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-474-1605
Mailing Address - Street 1:17150 NORWALK BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2751
Mailing Address - Country:US
Mailing Address - Phone:562-474-1605
Mailing Address - Fax:562-444-0456
Practice Address - Street 1:17150 NORWALK BLVD STE 104
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2751
Practice Address - Country:US
Practice Address - Phone:562-303-6662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-22
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty