Provider Demographics
NPI:1083337166
Name:GONZALEZ, NOZOMI GABRIELA (ND)
Entity Type:Individual
Prefix:
First Name:NOZOMI
Middle Name:GABRIELA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 SE 50TH AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3861
Mailing Address - Country:US
Mailing Address - Phone:269-267-9994
Mailing Address - Fax:
Practice Address - Street 1:49 S PORTER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-4873
Practice Address - Country:US
Practice Address - Phone:503-552-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X
OR4481175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath