Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | CA55443 | CA |
NPI | 1033377544 |
---|---|
Provider Name | Dr. Pedro Luis Gonzalez |
First Address | Ventura, CA 93004-1377 |
Second Address | Ventura, CA 93004-1377 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2008 |
Last Update Date | 22/03/2013 |