Provider Demographics
NPI:1518161629
Name:GONZALEZ, ANITA EMPERATRIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:EMPERATRIZ
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14649 VICTORY BLVD STE 20
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-4101
Mailing Address - Country:US
Mailing Address - Phone:818-786-8396
Mailing Address - Fax:818-901-7128
Practice Address - Street 1:14649 VICTORY BLVD STE 20
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-4101
Practice Address - Country:US
Practice Address - Phone:818-786-8396
Practice Address - Fax:818-901-7128
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100277208D00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice