Provider Demographics
NPI:1710162706
Name:GONZALEZ, MARIA (IDC)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:H100 SANTA MARGARITA ROAD
Mailing Address - Street 2:
Mailing Address - City:MARINE CORPS BASE CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92058
Mailing Address - Country:US
Mailing Address - Phone:760-763-7656
Mailing Address - Fax:
Practice Address - Street 1:H100 SANTA MARGARITA ROAD
Practice Address - Street 2:NAVAL HOSPITAL CAMP PENDLETON
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92058
Practice Address - Country:US
Practice Address - Phone:760-763-7656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman