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General NPI Number Information
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NPI Number | 1154314334
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Entity Type | Individual
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Provider Name | AURORA GONZAGA M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 195 WADSWORTH RD
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City | WADSWORTH
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State | OH
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Zip | 44281-9504
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Country | US
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Telephone | 330-334-2863
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 367
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City | MOGADORE
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State | OH
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Zip | 44260-0367
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Country | US
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Telephone | 330-628-1325
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35032393
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License Number State | OH
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