Provider Demographics
NPI:1679329106
Name:GONZALEZ, GLORIAMARIA (MD)
Entity Type:Individual
Prefix:
First Name:GLORIAMARIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FERNANDO DE ARGUELLO 6655
Mailing Address - Street 2:APT 23
Mailing Address - City:SANTIAGO
Mailing Address - State:ZZ - FOREIGN COUNTRIES
Mailing Address - Zip Code:7650674
Mailing Address - Country:CL
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ANTONIO VARAS 360
Practice Address - Street 2:SURGERY DEPARTMENT
Practice Address - City:SANTIAGO
Practice Address - State:ZZ - FOREIGN COUNTRIES
Practice Address - Zip Code:7650674
Practice Address - Country:CL
Practice Address - Phone:562-257-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ01064672086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery