Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A124749 | CA |
Y | 207RG0300X | Geriatric Medicine | A124749 | CA |
NPI | 1083905715 |
---|---|
Provider Name | Veronica Virgen Gonzalez |
First Address | San Diego, CA 92193-2410 |
Second Address | San Diego, CA 92103-9000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2011 |
Last Update Date | 26/10/2020 |