Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 2008009076 | MO |
Y | 207PP0204X | Pediatric Emergency Physician | 264679 | NY |
NPI | 1558467191 |
---|---|
Provider Name | Laura Kimberley Gonzalez |
First Address | Brooklyn, NY 11219-2916 |
Second Address | Brooklyn, NY 11219-2916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 04/09/2012 |