MEDICARE: DANIELA GONZALEZ

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	DDS110324	CA

General Provider Information

NPI Number	:	1396436887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELA GONZALEZ

Provider Business Mailing Address
First Line	:	7028 DAVENPORT CT
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91701-7501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7950 CHERRY AVE STE 101
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-4023
Country	:	US
Telephone Number	:	909-854-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2023
Last Update Date	:	08/27/2024

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Directions to “ DANIELA GONZALEZ ” Practice Location

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