Gonzales Medical Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

GONZALES MEDICAL CORPORATION

Doing business as

Divine Grace Medical Clinic

Practice address

17150 Norwalk Blvd Ste 104
Cerritos, CA 90703-2751

Phone

(562) 303-6662

NPI assigned

Nov 22, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mary Eppie Porciuncula Gonzales, MDNPI 1649231739

Title

Ceo

Phone

(562) 474-1605

Specialties & licenses 1

Addresses

Other names 1

• Divine Grace Medical Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary Eppie Porciuncula Gonzales, M.D.

  • Internal Medicine Physician
  • Cerritos, CA
  • NPI 1649231739
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1542844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590969600000",
    "number": "1447729272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17150 NORWALK BLVD STE 104",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907032751",
            "telephone_number": "562-474-1605",
            "fax_number": "562-444-0456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17150 NORWALK BLVD STE 104",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907032751",
            "telephone_number": "562-303-6662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GONZALES MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-22",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A",
        "authorized_official_last_name": "GONZALES",
        "authorized_official_first_name": "MARY EPPIE",
        "authorized_official_middle_name": "PORCIUNCULA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "562-474-1605",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Divine Grace Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joseph Chris Gutierrez Gomez
• Luis Gomez
• Maria Isabell Gomez
• Martha Gomez
• Nataly Gomez
• Mary Eppie Porciuncula Gonzales, M.D.
• Vanessa Gonzales
• Yemmi Gonzalez Acuna
• Andrea Gonzalez Macias
• Alejandra Gonzalez

• Internal Medicine Physician in Cerritos, CA
• Providers in Cerritos, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.