Active NPI
Robert John Gonzales
- Dermatology Physician
- Davis, CA
National Provider Identifier
1205720273
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- L10013
- Practice address
- 2050 Lyndell Ter Ste 104
Davis, CA 95616-6205 - Phone
- (530) 808-5318
- NPI assigned
- Jun 5, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | L10013 | CA | Primary |
Addresses
Primary practice location
2050 Lyndell Ter Ste 104
Davis, CA 95616-6205
Mailing address
2050 Lyndell Ter Ste 104
Davis, CA 95616-6205
Phone (530) 808-5318
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L10013 | CA | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1749081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749081600000",
"number": "1205720273",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2050 LYNDELL TER STE 104",
"city": "DAVIS",
"state": "CA",
"postal_code": "956166205",
"telephone_number": "530-808-5318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2050 LYNDELL TER STE 104",
"city": "DAVIS",
"state": "CA",
"postal_code": "956166205",
"telephone_number": "530-808-5318"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALES",
"first_name": "ROBERT",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-06-05",
"last_updated": "2025-06-05",
"certification_date": "2025-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": "CA",
"license": "L10013",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davis, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.