Provider Demographics
NPI:1457051401
Name:GONZALEZ HERNANDEZ, LUZ PATRICIA
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:PATRICIA
Last Name:GONZALEZ HERNANDEZ
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 1:10622 MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:92316-2641
Mailing Address - Country:US
Mailing Address - Phone:909-437-6393
Mailing Address - Fax:
Practice Address - Street 1:10622 MIAMI AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:CA
Practice Address - Zip Code:92316-2641
Practice Address - Country:US
Practice Address - Phone:909-437-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)