Healthcare Provider Details

I. General information

NPI: 1295178317
Provider Name (Legal Business Name): MISS ELIZABETH GONZALEZ LARIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS ELIZABETH LARIOS

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 E SAN FERNANDO ST
SAN JOSE CA
95112-3503
US

IV. Provider business mailing address

2625 ZANKER RD
SAN JOSE CA
95134-2130
US

V. Phone/Fax

Practice location:
  • Phone: 408-899-7152
  • Fax: 408-514-2385
Mailing address:
  • Phone: 408-468-0100
  • Fax: 408-944-0275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: