Healthcare Provider Details

I. General information

NPI: 1932751443
Provider Name (Legal Business Name): SAID M GONZALEZ MPH, RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45386 VIA NUBES
TEMECULA CA
92592-4909
US

IV. Provider business mailing address

45386 VIA NUBES
TEMECULA CA
92592-4909
US

V. Phone/Fax

Practice location:
  • Phone: 951-760-1489
  • Fax:
Mailing address:
  • Phone: 951-760-1489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86038429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: