Provider Demographics
NPI:1497952089
Name:GONZALEZ, MARGARITA JIMENEZ
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:JIMENEZ
Last Name:GONZALEZ
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 1:1444 LEMON ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2617
Mailing Address - Country:US
Mailing Address - Phone:760-407-1220
Mailing Address - Fax:760-414-3711
Practice Address - Street 1:1444 LEMON ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2617
Practice Address - Country:US
Practice Address - Phone:760-407-1220
Practice Address - Fax:760-414-3711
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator