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General NPI Number Information
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NPI Number | 1760440150
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Entity Type | Individual
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Provider Name | MARIA NINA A GONZALEZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 975 SERENO DR KAISER VALLEJO, DEPARTMENT OF NEUROLOGY
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City | VALLEJO
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State | CA
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Zip | 94589-2441
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Country | US
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Telephone | 707-651-1090
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Fax |
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Provider Business Mailing Address
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Address Line | 10810 SAN PABLO AVE APT # A313
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City | EL CERRITO
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State | CA
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Zip | 94530-2399
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Country | US
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Telephone | 508-826-0463
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 224130
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | A95478
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License Number State | CA
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