Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | R73243 | AZ |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 036.149385 | IL |
NPI | 1154684728 |
---|---|
Provider Name | Dr. Maritza G Gonzalez |
First Address | Chicago, IL 60637-1443 |
Second Address | Chicago, IL 60637-1443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2012 |
Last Update Date | 23/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036.149385 | (05) | IL |
036.149385 | LICENSE (01) | IL |