Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MD420289 | PA |
NPI | 1063485696 |
---|---|
Provider Name | Stephanie Gonzalez |
First Address | Pittsburgh, PA 15213-3410 |
Second Address | Pittsburgh, PA 15213-3410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 15/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G55075 | (02) | PA |