Provider Demographics
NPI:1275800047
Name:GONZALEZ-ALBAZZAZ, RINA CECILIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:RINA
Middle Name:CECILIA
Last Name:GONZALEZ-ALBAZZAZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:RINA
Other - Middle Name:CECILIA
Other - Last Name:GONZALEZ-INFANTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:620 WING ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-2800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 WING ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2800
Practice Address - Country:US
Practice Address - Phone:847-741-7370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190284351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice