Healthcare Provider Details

I. General information

NPI: 1770710832
Provider Name (Legal Business Name): VERONICA GONZALEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JOSE CLEMENTE OROZCO #10122 STE 406
TIJUANA BAJA CALIFORNIA
22000
MX

IV. Provider business mailing address

JOSE CLEMENTE OROZCO #10122 STE 406
TIJUANA BAJA CALIFORNIA
22000
MX

V. Phone/Fax

Practice location:
  • Phone: 619-489-0330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberMX3620678
License Number StateZZ

VIII. Authorized Official

Name: VERONICA GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 619-489-0330