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General NPI Number Information
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NPI Number | 1215814900
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Entity Type | Individual
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Provider Name | ANDRES GONZALEZ
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Gender | Male
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Dates
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Enumeration Date | 08/16/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 1245 7TH ST
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City | WASCO
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State | CA
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Zip | 93280-1820
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Country | US
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Telephone | 661-758-3021
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 430671
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City | SAN YSIDRO
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State | CA
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Zip | 92143-0671
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Country | US
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Telephone | 664-421-0452
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 112254
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License Number State | CA
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