Provider Demographics
NPI:1598059123
Name:GONZALES, ELIZABETH NEAL (RD)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:NEAL
Last Name:GONZALES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BON AIR RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1141
Mailing Address - Country:US
Mailing Address - Phone:415-927-0666
Mailing Address - Fax:415-927-6168
Practice Address - Street 1:2 BON AIR RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1141
Practice Address - Country:US
Practice Address - Phone:415-927-0666
Practice Address - Fax:415-927-6168
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA803875133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA803875OtherCOMMISSION ON DIETETIC REGISTRATION
CA803875OtherCOMMISSION ON DIETETIC REGISTRATION