Provider Demographics
NPI:1851968879
Name:GONZALEZ GUASCHINO, CARLA VIRGINIA (MD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:VIRGINIA
Last Name:GONZALEZ GUASCHINO
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 1:7901 BROADWAY DEPARTMENT OF MEDICINE
Mailing Address - Street 2:
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:781-334-4000
Mailing Address - Fax:
Practice Address - Street 1:7901 BROADWAY DEPARTMENT OF MEDICINE
Practice Address - Street 2:
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:781-334-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2023-05-19
Deactivation Date:2023-04-03
Deactivation Code:
Reactivation Date:2023-05-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program