Provider Demographics
NPI:1659403301
Name:GONZALEZ, MARIA YASMIN (DDS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:YASMIN
Last Name:GONZALEZ
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 1:1249 W GARDENA BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4884
Mailing Address - Country:US
Mailing Address - Phone:310-327-9392
Mailing Address - Fax:
Practice Address - Street 1:1249 W GARDENA BLVD STE 107
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4884
Practice Address - Country:US
Practice Address - Phone:310-327-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD44887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist