Provider Demographics
NPI:1073751582
Name:GONZALEZ, BELEM
Entity Type:Individual
Prefix:
First Name:BELEM
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-3611
Mailing Address - Country:US
Mailing Address - Phone:323-771-0248
Mailing Address - Fax:
Practice Address - Street 1:7101 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-3611
Practice Address - Country:US
Practice Address - Phone:323-771-0248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant