Provider Demographics
NPI:1609197052
Name:GONZAGA, CHRISTINA MARIA (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MARIA
Last Name:GONZAGA
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:834 CHESTNUT ST
Mailing Address - Street 2:T150
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5127
Mailing Address - Country:US
Mailing Address - Phone:215-955-2090
Mailing Address - Fax:215-923-5086
Practice Address - Street 1:834 CHESTNUT ST
Practice Address - Street 2:T150
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5127
Practice Address - Country:US
Practice Address - Phone:215-955-2090
Practice Address - Fax:215-923-5086
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS0150042081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine