Healthcare Provider Details

I. General information

NPI: 1366215543
Provider Name (Legal Business Name): ANGELA RUBI GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 100TH ST SE STE B
EVERETT WA
98208-3832
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 425-312-0202
  • Fax:
Mailing address:
  • Phone: 206-764-0502
  • Fax: 206-764-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberWDL2PP67G83B
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: