Provider Demographics
NPI:1366538340
Name:URBANO, GONZALO (MD)
Entity type:Individual
Prefix:
First Name:GONZALO
Middle Name:
Last Name:URBANO
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 1:2740 HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6813
Mailing Address - Country:US
Mailing Address - Phone:559-299-2578
Mailing Address - Fax:
Practice Address - Street 1:2740 HERNDON AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6813
Practice Address - Country:US
Practice Address - Phone:559-299-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY149379OtherWELLCARE HEALTH PLAN
NY180174-AIFOtherHEALTHFIRST
NY01237998Medicaid
NY040426028328OtherFIDELIS CARE
NY100087520001OtherUHC MEDICAID FHP
NY000330940101OtherHEALTH PLUS
NY180174POtherHEALTHCARE PARTNERS, INC. MEDICARE AND MEDICAID
NY149379OtherWELLCARE HEALTH PLAN
NY000330940101OtherHEALTH PLUS