Provider Demographics
NPI:1922725910
Name:GONZALEZ, GLORIA MH (RDN)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:MH
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16045 W BECKER LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4618
Mailing Address - Country:US
Mailing Address - Phone:623-512-0067
Mailing Address - Fax:
Practice Address - Street 1:16045 W BECKER LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-4618
Practice Address - Country:US
Practice Address - Phone:623-512-0067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered