Provider Demographics
NPI:1578576294
Name:GONZALEZ-DIAZ, GRISEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRISEL
Middle Name:
Last Name:GONZALEZ-DIAZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 ALRINGTON AVE
Mailing Address - Street 2:STE A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503
Mailing Address - Country:US
Mailing Address - Phone:951-785-4200
Mailing Address - Fax:951-785-9200
Practice Address - Street 1:7201 ALRINGTON AVE
Practice Address - Street 2:STE A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503
Practice Address - Country:US
Practice Address - Phone:951-785-4200
Practice Address - Fax:951-785-9200
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9359601OtherDENTICAL