Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 83285 | CA |
NPI | 1083013320 |
---|---|
Provider Name | Dr. Mario Cesar Gonzalez |
First Address | Santa Clarita, CA 91351-5524 |
Second Address | Santa Clarita, CA 91351-5524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2014 |
Last Update Date | 21/08/2014 |