Provider Demographics
NPI:1700021094
Name:GONZALES, RHODA LISA (RDHAP)
Entity Type:Individual
Prefix:
First Name:RHODA
Middle Name:LISA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:RHODA
Other - Middle Name:LISA
Other - Last Name:HOWELL-GONZALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 27011
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-7011
Mailing Address - Country:US
Mailing Address - Phone:559-960-2232
Mailing Address - Fax:
Practice Address - Street 1:11309 N VIA VERONA WAY
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-8823
Practice Address - Country:US
Practice Address - Phone:559-960-2232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist