Provider Demographics
NPI:1508083056
Name:GONZALEZ, VAL VERDE (DMD)
Entity Type:Individual
Prefix:DR
First Name:VAL
Middle Name:VERDE
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 S SAN VICENTE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4108
Mailing Address - Country:US
Mailing Address - Phone:310-360-0767
Mailing Address - Fax:310-659-2326
Practice Address - Street 1:426 S SAN VICENTE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4108
Practice Address - Country:US
Practice Address - Phone:310-360-0767
Practice Address - Fax:310-659-2326
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice