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NPI Code Detail

MEDICARE: MELIDA GONZALEZ L.AC.

MEDICARE: MELIDA GONZALEZ L.AC.
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
1171100000XAcupuncturist14428CA

General Provider Information

NPI Number : 1790053890
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELIDA GONZALEZ L.AC.
Provider Business Mailing Address
First Line : 8974 JANUARY PL
Second Line :
City : SAN DIEGO
State : CA
Zip : 92122-1549
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3320 2ND AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-5612
Country : US
Telephone Number : 619-253-7884
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2011
Last Update Date : 02/10/2016

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Directions to “ MELIDA GONZALEZ L.AC.” Practice Location

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