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General NPI Number Information
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NPI Number | 1063609196
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Entity Type | Organization
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Legal Business Name | GRISEL GONZALEZ-DIAZ INC
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 7201 ARLINGTON AVE STE A
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City | RIVERSIDE
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State | CA
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Zip | 92503-1518
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Country | US
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Telephone | 951-785-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 7201 ARLINGTON AVE STE A
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City | RIVERSIDE
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State | CA
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Zip | 92503-1518
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Country | US
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Telephone | 951-785-4200
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | MRS. GRISEL GONZALEZ-DIAZ
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Credential | DDS
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Telephone | 951-785-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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