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General NPI Number Information
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NPI Number | 1154616357
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Entity Type | Individual
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Provider Name | NINA GONZALEZ MD, MPH
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Gender | Female
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 2014 WASHINGTON ST
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City | NEWTON
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State | MA
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Zip | 02462-1607
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Country | US
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Telephone | 617-243-6467
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Fax | 617-243-6701
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Provider Business Mailing Address
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Address Line | 10629 PORTO CT
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City | SAN DIEGO
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State | CA
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Zip | 92124-2016
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 248917
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | MD455331
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License Number State | PA
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