Provider Demographics
NPI:1154846558
Name:GONZALEZ, MONICA (RDN, CDN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 STEWART AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6611
Mailing Address - Country:US
Mailing Address - Phone:917-365-3386
Mailing Address - Fax:
Practice Address - Street 1:2136 DEER PARK AVE # 14
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-1306
Practice Address - Country:US
Practice Address - Phone:917-365-3386
Practice Address - Fax:855-919-6143
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
985694133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered