Healthcare Provider Details

I. General information

NPI: 1063609196
Provider Name (Legal Business Name): GRISEL GONZALEZ-DIAZ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 ARLINGTON AVE STE A
RIVERSIDE CA
92503-1518
US

IV. Provider business mailing address

7201 ARLINGTON AVE STE A
RIVERSIDE CA
92503-1518
US

V. Phone/Fax

Practice location:
  • Phone: 951-785-4200
  • Fax:
Mailing address:
  • Phone: 951-785-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. GRISEL GONZALEZ-DIAZ
Title or Position: PRESIDENT OF CORPORATION
Credential: DDS
Phone: 951-785-4200