Basic Information
| Provider Information | |||||||||
| NPI: | 1013037993 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ-HOWARD | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4770 W HERNDON AVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937228401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592567990 | ||||||||
| FaxNumber: | 5592567991 | ||||||||
| Practice Location | |||||||||
| Address1: | 4770 W HERNDON AVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937228401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592567990 | ||||||||
| FaxNumber: | 5592567991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 10/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 01068349A | IN | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | A94656 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.