Healthcare Provider Details

I. General information

NPI: 1073319570
Provider Name (Legal Business Name): CORI M GONZALEZ L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 BREVARD RD STE 105
HORSE SHOE NC
28742-8809
US

IV. Provider business mailing address

157 PLANTATION DR
HENDERSONVILLE NC
28792-2446
US

V. Phone/Fax

Practice location:
  • Phone: 828-407-0246
  • Fax:
Mailing address:
  • Phone: 561-214-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLAC-1047
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: