Provider Demographics
NPI:1649552175
Name:GONZALEZ, CHRISTINE LYNN
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LYNN
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 1:1383 44TH AVE
Mailing Address - Street 2:APARTMENT. B
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1146
Mailing Address - Country:US
Mailing Address - Phone:856-498-7968
Mailing Address - Fax:
Practice Address - Street 1:1383 44TH AVE
Practice Address - Street 2:APARTMENT. B
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1146
Practice Address - Country:US
Practice Address - Phone:856-498-7968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-10
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program