Provider Demographics
NPI:1134200272
Name:GONZALEZ, MIGUEL A C (MD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A C
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 EASTLAKE PKWY STE 305
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4522
Mailing Address - Country:US
Mailing Address - Phone:310-344-3003
Mailing Address - Fax:
Practice Address - Street 1:890 EASTLAKE PKWY STE 305
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4522
Practice Address - Country:US
Practice Address - Phone:310-344-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA766532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry