MEDICARE: CHRISTINE LYNN 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

General Provider Information

NPI Number	:	1649552175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE LYNN GONZALEZ

Provider Business Mailing Address
First Line	:	1383 44TH AVE
Second Line	:	APARTMENT. B
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1146
Country	:	US
Telephone Number	:	856-498-7968
Fax Number	:

Provider Business Practice Location Address
First Line	:	1383 44TH AVE
Second Line	:	APARTMENT. B
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1146
Country	:	US
Telephone Number	:	856-498-7968
Fax Number	:

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

Provider Enumeration Date	:	09/10/2011
Last Update Date	:	09/10/2011

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