Healthcare Provider Details

I. General information

NPI: 1952813115
Provider Name (Legal Business Name): NORA TERESA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 HOTEL CIR N UNIT 320
SAN DIEGO CA
92108-2807
US

IV. Provider business mailing address

6160 MISSION GORGE RD STE 108
SAN DIEGO CA
92120-3425
US

V. Phone/Fax

Practice location:
  • Phone: 619-481-3850
  • Fax: 619-481-3851
Mailing address:
  • Phone: 619-481-5200
  • Fax: 619-481-5219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: