Basic Information
| Provider Information | |||||||||
| NPI: | 1942316898 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LESLIE M GONZALEZ MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3771 KATELLA AVE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | LOS ALAMITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622965232 | ||||||||
| FaxNumber: | 5622968379 | ||||||||
| Practice Location | |||||||||
| Address1: | 3771 KATELLA AVE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | LOS ALAMITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622965232 | ||||||||
| FaxNumber: | 5622968379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 01/27/2011 | ||||||||
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| AuthorizedOfficialLastName: | GONZALEZ | ||||||||
| AuthorizedOfficialFirstName: | LESLIE | ||||||||
| AuthorizedOfficialMiddleName: | MERCEDES | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5622965232 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | A76307 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.