Provider Demographics
NPI:1376933499
Name:GONZAGA, ROMINA
Entity Type:Individual
Prefix:MRS
First Name:ROMINA
Middle Name:
Last Name:GONZAGA
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 1:4120 PALISADES CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-6801
Mailing Address - Country:US
Mailing Address - Phone:845-348-6447
Mailing Address - Fax:845-875-7259
Practice Address - Street 1:4120 PALISADES CENTER DR
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-6801
Practice Address - Country:US
Practice Address - Phone:845-348-6447
Practice Address - Fax:845-875-7259
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician