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General NPI Number Information
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NPI Number | 1326516196
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Entity Type | Organization
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Legal Business Name | KATHY R. GONZALEZ O.D. L.L.C.
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Dates
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Enumeration Date | 11/09/2018
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Last Update Date | 11/09/2018
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Provider Practice Location Address
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Address Line | 14894 N STATE AVE
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City | MIDDLEFIELD
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State | OH
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Zip | 44062-9724
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Country | US
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Telephone | 440-632-1695
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Fax |
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Provider Business Mailing Address
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Address Line | 9813 FIRESTONE LN
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City | MACEDONIA
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State | OH
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Zip | 44056-1544
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Country | US
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Telephone | 330-348-9998
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATHY R GONZALEZ
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Credential | OD
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Telephone | 330-348-9998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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