Basic Information
| Provider Information | |||||||||
| NPI: | 1871601591 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | MERCEDES | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3771 KATELLA AVE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | LOS ALAMITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907203108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622965232 | ||||||||
| FaxNumber: | 5622968379 | ||||||||
| Practice Location | |||||||||
| Address1: | 3771 KATELLA | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | LOS ALAMITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907204013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622965232 | ||||||||
| FaxNumber: | 5622968379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 01/27/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | A76307 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
ID Information
| ID | Type | State | Issuer | Description | 00A763070 | 05 | CA | MEDICAID | 204322257 | 01 | CA | TAX ID | OTHER |