Healthcare Provider Details

I. General information

NPI: 1720289481
Provider Name (Legal Business Name): ANGELINA MARISSA GONZALEZ-TRUONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7734 N 59TH AVE
GLENDALE AZ
85301-7816
US

IV. Provider business mailing address

7734 N 59TH AVE
GLENDALE AZ
85301-7816
US

V. Phone/Fax

Practice location:
  • Phone: 623-931-2444
  • Fax:
Mailing address:
  • Phone: 623-931-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTRN11026
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME108093
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46847
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: