Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 64504 | CA |
NPI | 1023321668 |
---|---|
Provider Name | Miss Veronica Gonzalez |
First Address | Los Angeles, CA 90027-6302 |
Second Address | Covina, CA 91722-3762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2010 |
Last Update Date | 10/11/2015 |