Healthcare Provider Details

I. General information

NPI: 1558419002
Provider Name (Legal Business Name): ADA ELENA GONZALEZ ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 SE PARK ST
MILWAUKIE OR
97222-4545
US

IV. Provider business mailing address

5002 SE PARK ST
MILWAUKIE OR
97222-4545
US

V. Phone/Fax

Practice location:
  • Phone: 503-653-5960
  • Fax:
Mailing address:
  • Phone: 503-653-5960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number947
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: