Healthcare Provider Details

I. General information

NPI: 1306760368
Provider Name (Legal Business Name): ALEXIS GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N WAYNE ST APT 205
ARLINGTON VA
22201-1863
US

IV. Provider business mailing address

707 N WAYNE ST APT 205
ARLINGTON VA
22201-1863
US

V. Phone/Fax

Practice location:
  • Phone: 520-535-4097
  • Fax:
Mailing address:
  • Phone: 520-535-4097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202223783
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: