Provider Demographics
NPI:1922378819
Name:GONZALEZ, GREGORIA I
Entity Type:Individual
Prefix:MS
First Name:GREGORIA
Middle Name:
Last Name:GONZALEZ
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18050 ORANGE WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-4118
Mailing Address - Country:US
Mailing Address - Phone:909-275-9009
Mailing Address - Fax:
Practice Address - Street 1:18050 ORANGE WAY
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-4118
Practice Address - Country:US
Practice Address - Phone:909-275-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30557126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant