Healthcare Provider Details

I. General information

NPI: 1992613277
Provider Name (Legal Business Name): AMANDA GONZALEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 MARKET ST APT 1616
SAN FRANCISCO CA
94103-1853
US

IV. Provider business mailing address

1177 MARKET ST APT 1616
SAN FRANCISCO CA
94103-1853
US

V. Phone/Fax

Practice location:
  • Phone: 661-304-8312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: