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General NPI Number Information
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NPI Number | 1699810838
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Entity Type | Individual
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Provider Name | EDITH GONZALEZ-WERNER M. D.
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Gender | Female
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 47250 WASHINGTON ST STE A
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City | LA QUINTA
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State | CA
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Zip | 92253-2105
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Country | US
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Telephone | 760-771-9437
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Fax | 760-564-8581
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Provider Business Mailing Address
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Address Line | 47250 WASHINGTON ST STE A
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City | LA QUINTA
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State | CA
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Zip | 92253-2105
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Country | US
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Telephone | 760-771-9437
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Fax | 760-564-8581
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A0532670
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License Number State | CA
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