Provider Demographics
NPI:1780045567
Name:GONZALEZ, VERONICA ALICIA (ATC)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:ALICIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16216 APPLEBLOSSOM ST
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-5501
Mailing Address - Country:US
Mailing Address - Phone:626-533-6838
Mailing Address - Fax:
Practice Address - Street 1:16216 APPLEBLOSSOM ST
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-5501
Practice Address - Country:US
Practice Address - Phone:626-533-6838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2000017867171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor