Provider Demographics
NPI:1871601591
Name:GONZALEZ, LESLIE MERCEDES (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MERCEDES
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 1:3771 KATELLA AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3108
Mailing Address - Country:US
Mailing Address - Phone:562-296-5232
Mailing Address - Fax:562-296-8379
Practice Address - Street 1:3771 KATELLA
Practice Address - Street 2:SUITE 110
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-4013
Practice Address - Country:US
Practice Address - Phone:562-296-5232
Practice Address - Fax:562-296-8379
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76307207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A763070Medicaid
CA204322257OtherTAX ID
CA204322257OtherTAX ID
CA00A763070Medicaid