Healthcare Provider Details

I. General information

NPI: 1700021094
Provider Name (Legal Business Name): RHODA LISA GONZALES RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RHODA LISA HOWELL-GONZALES

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11309 N VIA VERONA WAY
FRESNO CA
93730-8823
US

IV. Provider business mailing address

PO BOX 27011
FRESNO CA
93729-7011
US

V. Phone/Fax

Practice location:
  • Phone: 559-960-2232
  • Fax:
Mailing address:
  • Phone: 559-960-2232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: