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NPI Code Detail

MEDICARE: DEIRDRE GONZALEZ MASTERS DEGREE(SE)

MEDICARE: DEIRDRE GONZALEZ MASTERS DEGREE(SE)
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist1380949NY

General Provider Information

NPI Number : 1225389471
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEIRDRE GONZALEZ MASTERS DEGREE(SE)
Provider Business Mailing Address
First Line : 350 E 143RD ST APT 10D
Second Line :
City : BRONX
State : NY
Zip : 10454-1206
Country : US
Telephone Number : 917-703-2726
Fax Number :
Provider Business Practice Location Address
First Line : 350 E 143RD ST APT 10D
Second Line :
City : BRONX
State : NY
Zip : 10454-1206
Country : US
Telephone Number : 917-703-2726
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2012
Last Update Date : 09/27/2012

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Directions to “ DEIRDRE GONZALEZ MASTERS DEGREE(SE)” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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