Healthcare Provider Details

I. General information

NPI: 1821972670
Provider Name (Legal Business Name): ELIZABETH UBALDA DEL CARMEN GONZALEZ CMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH UBALDA MENDOZA VASQUEZ CMA, MASTER DEGREE

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 HOLLISTER ST UNIT 22
SAN DIEGO CA
92154-4531
US

IV. Provider business mailing address

28475 MOUNTAIN ST
LAKE ELSINORE CA
92530-1714
US

V. Phone/Fax

Practice location:
  • Phone: 619-666-4451
  • Fax:
Mailing address:
  • Phone: 619-359-7386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: