Provider Demographics
NPI:1194721167
Name:GONZALEZ, MELVIN A (MD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:A
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 1:39000 BOB HOPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-346-0642
Mailing Address - Fax:760-837-8623
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-346-0642
Practice Address - Fax:760-837-8623
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46612174400000X
CA46612207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060004805OtherRAILROAD MEDICARE
CA00G466120OtherBLUE SHIELD PROV. #
CA00G466120Medicaid
CAA50436Medicare UPIN
CA00G466120OtherBLUE SHIELD PROV. #
CAZZZ23047ZMedicare PIN