Provider Demographics
NPI:1295789154
Name:GONZALEZ, VICTOR CRISTIAN (SA-C)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:CRISTIAN
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3S520 BATAVIA RD
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3302
Mailing Address - Country:US
Mailing Address - Phone:630-836-1142
Mailing Address - Fax:630-836-1142
Practice Address - Street 1:3S520 BATAVIA RD
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3302
Practice Address - Country:US
Practice Address - Phone:630-836-1142
Practice Address - Fax:630-836-1142
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO05-252246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant