Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95002251 | CA |
NPI | 1003209933 |
---|---|
Provider Name | Leticia Mariana Gonzalez |
First Address | Berkeley, CA 94710-2412 |
Second Address | El Cerrito, CA 94530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2015 |
Last Update Date | 27/08/2021 |