Healthcare Provider Details

I. General information

NPI: 1134366420
Provider Name (Legal Business Name): MRS. MAGDALENA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 N TUSTIN ST
ORANGE CA
92867-7716
US

IV. Provider business mailing address

6100 ORANGE AVE APT. #9
LONG BEACH CA
90805-3064
US

V. Phone/Fax

Practice location:
  • Phone: 714-288-1035
  • Fax: 714-288-2784
Mailing address:
  • Phone: 562-428-9492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: