Healthcare Provider Details

I. General information

NPI: 1073691382
Provider Name (Legal Business Name): HECTOR VIZZERA GONZALEZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 E VIRGINIA AVE
PHOENIX AZ
85004-1208
US

IV. Provider business mailing address

380 E VIRGINIA AVE
PHOENIX AZ
85004-1208
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-1255
  • Fax: 623-294-6626
Mailing address:
  • Phone: 602-258-1255
  • Fax: 623-294-6626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3331
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: