Individual
NICOLAS ANTONIO GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2600 E SOUTHERN AVE, BLDG. H, TEMPE, AZ 85282
(480) 699-7248
(480) 664-1961
Mailing address
2600 E SOUTHERN AVE, BLDG. H, TEMPE, AZ 85282
(480) 699-7248
(480) 664-1961
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
29730
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3Z0260
HEALTHNET
AZ
05
—
610560
—
AZ
Enumeration date
07/15/2005
Last updated
06/08/2011
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