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General NPI Number Information
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NPI Number | 1609979558
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Entity Type | Individual
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Provider Name | ELIA R GONZALEZ-RODRIGUEZ MD
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Gender | Female
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 601 MAIN ST STE 505
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City | VANCOUVER
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State | WA
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Zip | 98660-3414
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Country | US
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Telephone | 360-773-6340
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Fax | 360-326-2606
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Provider Business Mailing Address
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Address Line | 16420 SE MCGILLIVRAY BLVD STE 103-253
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City | VANCOUVER
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State | WA
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Zip | 98683-3461
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Country | US
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Telephone | 801-648-5520
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 7310134-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD60021935
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License Number State | WA
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