Healthcare Provider Details

I. General information

NPI: 1023321668
Provider Name (Legal Business Name): VERONICA GONZALEZ D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W BADILLO ST
COVINA CA
91722-3762
US

IV. Provider business mailing address

4470 W SUNSET BLVD 256
LOS ANGELES CA
90027-6302
US

V. Phone/Fax

Practice location:
  • Phone: 626-331-0506
  • Fax:
Mailing address:
  • Phone: 714-270-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number64504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: