Individual provider Active NPI

Allyson Ann Gonzalez, M.D.

  • Obstetrics & Gynecology Physician
  • Santa Monica, CA
National Provider Identifier
1720131501
Registry record updated Feb 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
G79621 Issued in CA
Practice address
1333 Ocean Ave
Santa Monica, CA 90401-1023
Phone
(310) 420-6546
Fax
(310) 394-0739
NPI assigned
Jan 18, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X G79621 CA Primary

Addresses

Primary practice location

1333 Ocean Ave
Santa Monica, CA 90401-1023

Mailing address

1333 Ocean Ave
Santa Monica, CA 90401-1023
Phone (310) 420-6546

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ59915ZOtherCABLUE SHIELD OF CAILFORNIA

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G79621CAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gail N Jackson MD PC Past Accepting new patients
Lisa M. Masterson MD a Professional Corporation PastSince Jul 25, 2017 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519689600000",
    "number": "1720131501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 OCEAN AVE",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904011023",
            "telephone_number": "310-420-6546",
            "fax_number": "310-394-0739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 OCEAN AVE",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904011023",
            "telephone_number": "310-420-6546",
            "fax_number": "310-394-0739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "ALLYSON",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-18",
        "last_updated": "2018-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "G79621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CAILFORNIA",
            "identifier": "ZZZ59915Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.