Healthcare Provider Details

I. General information

NPI: 1346300241
Provider Name (Legal Business Name): DIANA PATRICIA GONZALEZ AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/18/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 N MAIN ST STE C
BRISTOL CT
06010
US

IV. Provider business mailing address

440 N MAIN ST STE C
BRISTOL CT
06010
US

V. Phone/Fax

Practice location:
  • Phone: 860-893-1977
  • Fax: 860-845-5330
Mailing address:
  • Phone: 203-710-6150
  • Fax: 860-561-5094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000444
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number000444
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: