=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831077510
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAOLA GONZALEZ GUTIERREZ DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2025
-----------------------------------------------------
Last Update Date | 08/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3737 MURPHY CANYON RD STE C-2
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92123-4454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-751-6244
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2445 TUNICA CIR
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92111-5924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-779-8915
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 112242
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------