Provider Demographics
NPI:1083870463
Name:GONZALEZ, MARISA C (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:C
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:823 GATEWAY CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4541
Mailing Address - Country:US
Mailing Address - Phone:619-515-2300
Mailing Address - Fax:619-269-0674
Practice Address - Street 1:1809 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113
Practice Address - Country:US
Practice Address - Phone:619-515-2300
Practice Address - Fax:619-269-0674
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2018-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA120499207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology