Provider Demographics
NPI:1699830653
Name:GONZALES, YOLANDA DELFIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:DELFIN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 FRUITRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822
Mailing Address - Country:US
Mailing Address - Phone:916-421-1010
Mailing Address - Fax:916-421-5380
Practice Address - Street 1:2378 FRUITRIDGE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822
Practice Address - Country:US
Practice Address - Phone:916-421-1010
Practice Address - Fax:916-421-5380
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40440122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4044001OtherDENTICAL