Basic Information
| Provider Information | |||||||||
| NPI: | 1477585776 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | N | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 990208 | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960990208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365529113 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1555 EAST ST | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960011153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302461240 | ||||||||
| FaxNumber: | 5302461252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | G66820 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00G668201 | 05 | CA | MEDICAID |