Provider Demographics
NPI:1952813115
Name:GONZALEZ, NORA TERESA
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:TERESA
Last Name:GONZALEZ
Suffix:
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 1:6160 MISSION GORGE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3425
Mailing Address - Country:US
Mailing Address - Phone:619-481-5200
Mailing Address - Fax:619-481-5219
Practice Address - Street 1:1660 HOTEL CIR N UNIT 320
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2807
Practice Address - Country:US
Practice Address - Phone:619-481-3850
Practice Address - Fax:619-481-3851
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator