Provider Demographics
NPI:1740428416
Name:GOZE, CELIA ALEJANDRIA (RDA)
Entity Type:Individual
Prefix:MRS
First Name:CELIA
Middle Name:ALEJANDRIA
Last Name:GOZE
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 LAKME AVE APT NO 6
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-4646
Mailing Address - Country:US
Mailing Address - Phone:310-830-8195
Mailing Address - Fax:
Practice Address - Street 1:916 LAKME AVE APT NO 6
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-4646
Practice Address - Country:US
Practice Address - Phone:310-830-8195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61934126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant