MEDICARE: MISS VERONICA GONZALEZ D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	64504	CA

General Provider Information

NPI Number	:	1023321668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS VERONICA GONZALEZ D.D.S.

Provider Business Mailing Address
First Line	:	4470 W SUNSET BLVD
Second Line	:	256
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6302
Country	:	US
Telephone Number	:	714-270-0772
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 W BADILLO ST
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91722-3762
Country	:	US
Telephone Number	:	626-331-0506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2010
Last Update Date	:	11/10/2015

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