Provider Demographics
NPI:1619433729
Name:GONZALEZ, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 N REDWOOD DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1965
Mailing Address - Country:US
Mailing Address - Phone:415-521-6847
Mailing Address - Fax:415-849-1237
Practice Address - Street 1:185 N REDWOOD DR STE 120
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1965
Practice Address - Country:US
Practice Address - Phone:415-521-6847
Practice Address - Fax:415-849-1237
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA214700026374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide